Provider Demographics
NPI:1861602377
Name:WELLNESS ASSOCIATES S C
Entity type:Organization
Organization Name:WELLNESS ASSOCIATES S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:SULTAN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:847-729-2320
Mailing Address - Street 1:2150 PFINGSTEN RD
Mailing Address - Street 2:SUITE 2250
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1361
Mailing Address - Country:US
Mailing Address - Phone:847-729-2320
Mailing Address - Fax:
Practice Address - Street 1:2150 PFINGSTEN RD
Practice Address - Street 2:SUITE 2250
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1361
Practice Address - Country:US
Practice Address - Phone:847-729-2320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36052094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC42328Medicare UPIN
IL253080Medicare PIN
253080Medicare ID - Type Unspecified