Provider Demographics
NPI:1376153437
Name:BAAL PERAZIM WELLNESS AND HEALTH SERVICES PC
Entity Type:Organization
Organization Name:BAAL PERAZIM WELLNESS AND HEALTH SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWNLEE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-FPA
Authorized Official - Phone:404-548-1212
Mailing Address - Street 1:2835 N SHEFFIELD AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5084
Mailing Address - Country:US
Mailing Address - Phone:773-296-2400
Mailing Address - Fax:404-496-7073
Practice Address - Street 1:2835 N SHEFFIELD AVE STE 500
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5084
Practice Address - Country:US
Practice Address - Phone:773-296-2400
Practice Address - Fax:773-296-1097
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAAL PERAZIM WELLNESS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-04
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL253231187001Medicaid