Provider Demographics
NPI:1235479510
Name:PERSONALIZED WELLNESS INTERNAL MEDICINE INC
Entity Type:Organization
Organization Name:PERSONALIZED WELLNESS INTERNAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-884-3920
Mailing Address - Street 1:3150 W HIGGINS RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-7237
Mailing Address - Country:US
Mailing Address - Phone:847-884-3920
Mailing Address - Fax:
Practice Address - Street 1:3150 W HIGGINS RD
Practice Address - Street 2:SUITE 120
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-7237
Practice Address - Country:US
Practice Address - Phone:847-884-3920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty