MEDICARE: MEDILINE WELLNESS CENTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	D2823	TX

General Provider Information

NPI Number	:	1811229503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDILINE WELLNESS CENTER

Provider Business Mailing Address
First Line	:	6550 MAPLERIDGE ST STE 214
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4647
Country	:	US
Telephone Number	:	713-432-9400
Fax Number	:	713-432-9401

Provider Business Practice Location Address
First Line	:	6550 MAPLERIDGE ST STE 214
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4647
Country	:	US
Telephone Number	:	713-432-9400
Fax Number	:	713-432-9401

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	GERALD RATINOV
Credential	:	MD
Telephone Number	:	713-432-9400

Provider Enumeration Date	:	02/04/2010
Last Update Date	:	02/04/2010

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Directions to “MEDILINE WELLNESS CENTER ” Practice Location

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