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General NPI Number Information
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NPI Number | 1215403530
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Entity Type | Organization
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Legal Business Name | BAAL PERAZIM WELLNESS, INC
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Dates
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Enumeration Date | 10/15/2018
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 3416 S HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60608-6708
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Country | US
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Telephone | 773-296-2400
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Fax | 773-296-1097
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Provider Business Mailing Address
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Address Line | 2835 N SHEFFIELD AVE STE 500
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City | CHICAGO
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State | IL
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Zip | 60657-5084
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Country | US
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Telephone | 773-296-2400
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Fax | 773-296-1097
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAURICE BROWNLEE
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Credential | APRN
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Telephone | 773-296-2400
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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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