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General NPI Number Information
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NPI Number | 1841735909
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Entity Type | Organization
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Legal Business Name | WELLNESS MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 12/28/2016
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Last Update Date | 12/28/2016
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Provider Practice Location Address
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Address Line | 3033 SULLIVANT AVE
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City | COLUMBUS
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State | OH
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Zip | 43204-2424
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Country | US
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Telephone | 614-670-7771
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Fax | 614-385-7771
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Provider Business Mailing Address
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Address Line | 3033 SULLIVANT AVE
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City | COLUMBUS
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State | OH
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Zip | 43204-2424
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Country | US
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Telephone | 614-670-7771
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Fax | 614-385-7771
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Authorized Official
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Title or Position | OWNER
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Name | MUHAMMAD ASHRAF
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Credential | M.D.
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Telephone | 614-670-7771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 35-082017
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License Number State | OH
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