Provider Demographics
NPI:1255350120
Name:WELLNESS PROFESSIONALS LTD
Entity type:Organization
Organization Name:WELLNESS PROFESSIONALS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-667-1900
Mailing Address - Street 1:710 S MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-1817
Mailing Address - Country:US
Mailing Address - Phone:618-667-1900
Mailing Address - Fax:618-667-1919
Practice Address - Street 1:710 S MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-1817
Practice Address - Country:US
Practice Address - Phone:618-667-1900
Practice Address - Fax:618-667-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097781207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty