Provider Demographics
NPI:1225757032
Name:WELLCARE HEALTH PLLC
Entity Type:Organization
Organization Name:WELLCARE HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREEM
Authorized Official - Middle Name:
Authorized Official - Last Name:SYED SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:630-748-9407
Mailing Address - Street 1:2553 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4019
Mailing Address - Country:US
Mailing Address - Phone:773-784-1025
Mailing Address - Fax:773-784-1056
Practice Address - Street 1:2553 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4019
Practice Address - Country:US
Practice Address - Phone:773-784-1025
Practice Address - Fax:773-784-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)