Healthcare Provider Details

I. General information

NPI: 1013534155
Provider Name (Legal Business Name): BETTER LIFE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2020
Last Update Date: 07/05/2020
Certification Date: 07/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 WILLOWCREEK RD
PORTAGE IN
46368-5015
US

IV. Provider business mailing address

8334 BEECH AVE
MUNSTER IN
46321-1440
US

V. Phone/Fax

Practice location:
  • Phone: 312-933-0661
  • Fax:
Mailing address:
  • Phone: 312-933-0661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OLUSOLA OLOWE
Title or Position: CEO
Credential: MD
Phone: 312-933-0661