Provider Demographics
NPI:1144653395
Name:MODERN WELLNESS INC
Entity type:Organization
Organization Name:MODERN WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:OLTEAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-620-2023
Mailing Address - Street 1:2835 N SHEFFIELD AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5084
Mailing Address - Country:US
Mailing Address - Phone:773-525-6955
Mailing Address - Fax:480-287-8538
Practice Address - Street 1:2835 N SHEFFIELD AVE STE 500
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5084
Practice Address - Country:US
Practice Address - Phone:773-525-6955
Practice Address - Fax:480-287-8538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty