Provider Demographics
NPI:1447728134
Name:WELLCARE PROFESSIONALS LLC
Entity type:Organization
Organization Name:WELLCARE PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:FARHAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-506-1136
Mailing Address - Street 1:21175 TOMBALL PKWY # 504
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-1655
Mailing Address - Country:US
Mailing Address - Phone:214-506-1136
Mailing Address - Fax:214-705-3786
Practice Address - Street 1:1109 E 5TH ST STE B
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3318
Practice Address - Country:US
Practice Address - Phone:903-354-0231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-12
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty