Provider Demographics
NPI:1801056759
Name:WELLNESS PARTNERS, SC
Entity type:Organization
Organization Name:WELLNESS PARTNERS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-924-0279
Mailing Address - Street 1:131 E PARK AVE
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2800
Mailing Address - Country:US
Mailing Address - Phone:847-968-2800
Mailing Address - Fax:847-968-2801
Practice Address - Street 1:131 E PARK AVE
Practice Address - Street 2:SUITE # 103
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2800
Practice Address - Country:US
Practice Address - Phone:847-968-2800
Practice Address - Fax:847-968-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103630207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH36585Medicare UPIN