Provider Demographics
NPI:1457725277
Name:MEN'S WELLNESS AND TESTOSTERONE CENTER, LLC
Entity Type:Organization
Organization Name:MEN'S WELLNESS AND TESTOSTERONE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GULAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:WAHEED
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-212-1538
Mailing Address - Street 1:945 W STACY RD STE 120
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5077
Mailing Address - Country:US
Mailing Address - Phone:214-212-1538
Mailing Address - Fax:
Practice Address - Street 1:945 W STACY RD STE 120
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5077
Practice Address - Country:US
Practice Address - Phone:214-212-1538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0923208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty