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General NPI Number Information
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NPI Number | 1003218223
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Entity Type | Organization
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Legal Business Name | MEDICAL WELLNESS GROUP LLC
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Dates
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Enumeration Date | 09/18/2014
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 1359 NE 35TH AVENUE
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City | PORTLAND
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State | OR
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Zip | 97232
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Country | US
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Telephone | 503-389-5545
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Fax |
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Provider Business Mailing Address
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Address Line | 6222 SOARING AVE
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City | TEMPLE TERRACE
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State | FL
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Zip | 33617-1391
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Country | US
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Telephone | 813-765-1930
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUZANNE A SALHAB
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Credential | M.D.
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Telephone | 503-389-5545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME119290
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD167486
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License Number State | OR
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