Provider Demographics
NPI:1053838870
Name:UNIVERSAL WELLNESS GROUP
Entity Type:Organization
Organization Name:UNIVERSAL WELLNESS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AMOAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-238-9900
Mailing Address - Street 1:PO BOX 20185
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34204-0185
Mailing Address - Country:US
Mailing Address - Phone:941-238-9900
Mailing Address - Fax:941-238-9770
Practice Address - Street 1:1220 59TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209
Practice Address - Country:US
Practice Address - Phone:941-238-9900
Practice Address - Fax:941-238-9770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279495100Medicaid