Provider Demographics
NPI:1447772926
Name:A WELLNESS PHYSICIAN GROUP LLC
Entity Type:Organization
Organization Name:A WELLNESS PHYSICIAN GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:AHSAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-767-3822
Mailing Address - Street 1:821 E SCHAUMBURG RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3654
Mailing Address - Country:US
Mailing Address - Phone:630-289-2225
Mailing Address - Fax:773-337-9106
Practice Address - Street 1:821 E SCHAUMBURG RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3654
Practice Address - Country:US
Practice Address - Phone:630-289-2225
Practice Address - Fax:773-337-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010462261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center