MEDICARE: INTEGRATED WELLNESS CLINICS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207KA0200X	Allergy Physician
2	208D00000X	General Practice Physician
3	2083P0901X	Public Health & General Preventive Medicine Physician

General Provider Information

NPI Number	:	1144792615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED WELLNESS CLINICS PLLC

Provider Business Mailing Address
First Line	:	3308 PRESTON RD STE 350-307
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-7453
Country	:	US
Telephone Number	:	469-931-0684
Fax Number	:	469-931-0712

Provider Business Practice Location Address
First Line	:	3308 PRESTON RD STE 350-307
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-7453
Country	:	US
Telephone Number	:	469-931-0684
Fax Number	:	469-931-0712

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. TIMOTHY MCAULIFF
Credential	:	MD
Telephone Number	:	469-931-0684

Provider Enumeration Date	:	12/21/2018
Last Update Date	:	03/18/2019

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