Provider Demographics
NPI:1205176575
Name:PHYSICIANS HOLISTIC HEALTH ALLIANCE, LLC
Entity type:Organization
Organization Name:PHYSICIANS HOLISTIC HEALTH ALLIANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:UTHMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-273-3880
Mailing Address - Street 1:53760 GENERATIONS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1539
Mailing Address - Country:US
Mailing Address - Phone:574-273-3880
Mailing Address - Fax:574-271-0918
Practice Address - Street 1:53760 GENERATIONS DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1539
Practice Address - Country:US
Practice Address - Phone:574-273-3880
Practice Address - Fax:574-271-0918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054192A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty