Provider Demographics
NPI:1407571359
Name:BIOWELL HEALTH LLC
Entity Type:Organization
Organization Name:BIOWELL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGON
Authorized Official - Suffix:IV
Authorized Official - Credentials:
Authorized Official - Phone:781-708-2222
Mailing Address - Street 1:1175 CREEKSIDE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-2068
Mailing Address - Country:US
Mailing Address - Phone:844-276-9700
Mailing Address - Fax:
Practice Address - Street 1:1175 CREEKSIDE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-2068
Practice Address - Country:US
Practice Address - Phone:844-276-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty