Healthcare Provider Details

I. General information

NPI: 1841735909
Provider Name (Legal Business Name): WELLNESS MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2016
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 SULLIVANT AVE
COLUMBUS OH
43204-2424
US

IV. Provider business mailing address

3033 SULLIVANT AVE
COLUMBUS OH
43204-2424
US

V. Phone/Fax

Practice location:
  • Phone: 614-670-7771
  • Fax: 614-385-7771
Mailing address:
  • Phone: 614-670-7771
  • Fax: 614-385-7771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number35-082017
License Number StateOH

VIII. Authorized Official

Name: MUHAMMAD ASHRAF
Title or Position: OWNER
Credential: M.D.
Phone: 614-670-7771