Provider Demographics
NPI:1003325960
Name:DIABETES WELLNESS CLINIC PLLC
Entity Type:Organization
Organization Name:DIABETES WELLNESS CLINIC PLLC
Other - Org Name:DIABETES WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DILON
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-524-4043
Mailing Address - Street 1:11404 MISTY MORNING ST
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8374
Mailing Address - Country:US
Mailing Address - Phone:832-524-4043
Mailing Address - Fax:
Practice Address - Street 1:10970 SHADOW CREEK PKWY STE 260
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-0121
Practice Address - Country:US
Practice Address - Phone:832-524-4043
Practice Address - Fax:832-524-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-23
Last Update Date:2017-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6339261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty