Wellness Professionals LTD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036097781 Issued in IL

Legal business name

WELLNESS PROFESSIONALS LTD

Practice address

710 S Main St
Suite 2
Troy, IL 62294-1817

Phone

(618) 667-1900

Fax

(618) 667-1919

NPI assigned

Jul 19, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Alan Hagen, MD

Title

Owner

Phone

(618) 667-1900

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338768000000",
    "number": "1255350120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 S MAIN ST",
            "address_2": "SUITE 2",
            "city": "TROY",
            "state": "IL",
            "postal_code": "622941817",
            "telephone_number": "618-667-1900",
            "fax_number": "618-667-1919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 S MAIN ST",
            "address_2": "SUITE 2",
            "city": "TROY",
            "state": "IL",
            "postal_code": "622941817",
            "telephone_number": "618-667-1900",
            "fax_number": "618-667-1919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS PROFESSIONALS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2012-06-04",
        "status": "A",
        "authorized_official_last_name": "HAGEN",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-667-1900",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036097781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jennifer Wildhaber, ATR LCPC

• Internal Medicine Physician in Troy, IL
• Providers in Troy, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.