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General NPI Number Information
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NPI Number | 1184331514
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Entity Type | Organization
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Legal Business Name | WELLBE MEDICAL GROUP OF WEST VIRGINIA INC
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Dates
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Enumeration Date | 11/04/2022
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 411 1/2 D ST SUITE 3 SOUTH
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City | CHARLESTON
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State | WV
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Zip | 25303
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Country | US
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Telephone | 855-997-7900
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Fax |
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Provider Business Mailing Address
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Address Line | 225 W WASHINGTON ST STE 1500
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City | CHICAGO
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State | IL
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Zip | 60606-3485
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | IYAD HOUSHAN
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Credential | MD
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Telephone | 312-776-2415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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