AGELESS WELLNESS CENTER, INC (NPI# 1245672856) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1245672856 |
| Entity Type | Organization |
| Organization Name | AGELESS WELLNESS CENTER, INC |
| Practice Address |
2745 W Layton Ave Suite 203 Milwaukee WI 53221-2651 |
| Mailing Address |
Po Box 639 Thiensville WI 53092-0639 |
| Practice Telephone | 4144755800 |
| Practice Fax Number | 4144755400 |
| Mailing Telephone | 4142479005 |
| Mailing Fax Number | 4142479004 |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2014-05-02 |
| Authorized Official Name | DR. ABDULLATTIEF A SULIEMAN (PRESIDENT/OWNER) |
| Authorized Official Telephone | 4144755800 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 51008 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | MEDICARE | K100110473 | 01 |
| WI | 1881864197 | 05 |
| Street Address |
2745 W LAYTON AVE SUITE 203 |
| City | MILWAUKEE |
| State | WI |
| Zip Code | 53221-2651 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871586560 | Fernando T. Itable | Internal Medicine | 2745 W Layton Ave, Suite 3201, Milwaukee, WI 53221-2651 | 2005-08-26 |
| 1730440470 | Maximo L. Cueto Jr. M.d.s.c. | Clinic/Center | 2745 W Layton Ave, Suite 102, Milwaukee, WI 53221-2651 | 2012-05-30 |
| 1447580881 | Kaushalya Beniwal M D S C | Family Medicine | 2745 W Layton Ave, Suite 104, Milwaukee, WI 53221-2651 | 2010-01-07 |
| 1639353204 | Anilkumar Singh Md Sc | Surgery | 2745 W Layton Ave, Suite 202, Milwaukee, WI 53221-2651 | 2007-12-19 |
| 1316051063 | National Pedorthic Services, Inc. | Prosthetic/Orthotic Supplier | 2745 W Layton Ave, Suite 103, Milwaukee, WI 53221-2651 | 2006-08-19 |
| 1003826892 | Rodrigo Itable | Family Medicine | 2745 W Layton Ave, Suite 201, Milwaukee, WI 53221-2651 | 2006-08-08 |
| 1760408058 | Kaushalya Beniwal | Family Medicine | 2745 W Layton Ave, Suite # 104, Milwaukee, WI 53221-2651 | 2006-07-14 |
| 1902879810 | Debra L Kneisler | Physician Assistant | 2745 W Layton Ave, Suite 206, Milwaukee, WI 53221-2651 | 2006-02-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487205944 | Hayat Pharmacy 20 LLC | Pharmacy | 805 W. Layton Ave., Suite B, Milwaukee, WI 53221 | 2019-09-26 |
| 1962053421 | Hayat Pharmacy 19 LLC | Pharmacy | 805 W. Layton Ave. Suite A, Milwaukee, WI 53221 | 2019-09-26 |
| 1407343965 | Informe Healthcare LLC | Counselor | 2741 W Layton Ave., Suite 106, Milwaukee, WI 53221 | 2018-04-19 |
| 1447781992 | Itamar Yaakov Gnatt | Emergency Medicine | 2900 W Oklahoma Ave, St Lukes Medical Center, Milwaukee, WI 53221 | 2017-03-27 |
| 1194277160 | Suzanne Derosier | Licensed Practical Nurse | 3910 W Bridge, Greenfield, WI 53221 | 2016-10-26 |
| 1265988117 | Obi Home Care | Clinic/Center | 4439 S 20th St, Milwaukee, WI 53221 | 2016-08-31 |
| 1427430602 | Zezenya Health Care S.c. | Pain Medicine | 5114 S 27th St # 763, Milwaukee, WI 53221 | 2015-06-24 |
| 1851771091 | Feisal J Salahadyn | Counselor | 4800 South 10th Street, Milwaukee, WI 53221 | 2015-06-03 |
| 1114312386 | Holistic Home Health Care Incorporated | Adult Companion | 3422 West Howard Ave, Greenfield, WI 53221 | 2015-04-03 |
| 1841698834 | Srt Prosthetics & Orthotics LLC | Prosthetic/Orthotic Supplier | 5220 S 27th St., Milwaukee, WI 53221 | 2014-12-08 |
| Find all providers in zip 53221 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871769919 | Richard Winston Meyers | General Practice | 11050 Liberty Dr, Milwaukee, WI 53224-3630 | 2008-05-07 |
| 1144492273 | Amanda Courtney Reiswig | General Practice | 1233 N Mayfair Rd Ste 208, Milwaukee, WI 53226-3255 | 2008-03-28 |
| 1063496131 | Eldon J Swenson | General Practice | 620 S 76th St, Suite 240, Milwaukee, WI 53214-1599 | 2005-12-02 |
| 1467093864 | Der Yang | General Practice | 5800 W Burleigh St, Milwaukee, WI 53210-1516 | 2019-10-07 |
| 1821559550 | Kamal Sammy Al-shalby | General Practice | 8701 W Watertown Plank Rd, Milwaukee, WI 53226-3548 | 2019-03-26 |
| 1659831816 | Rachel Louise Feltman-frank | General Practice | 8701 W Watertown Plank Rd, Milwaukee, WI 53226-3548 | 2019-03-23 |
| 1518427145 | Zabrina Leann Ebert | General Practice | 8701 Watertown Plank Road, Milwaukee, WI 53226-0509 | 2019-03-20 |
| 1104323765 | Kayla Jean Schenheit | General Practice | 8701 W Watertown Plank Rd, Milwaukee, WI 53226-3548 | 2018-04-10 |
| 1831621341 | Peter Devries | General Practice | 8701 W Watertown Plank Rd, Milwaukee, WI 53226-3548 | 2017-04-03 |
| 1962934265 | Hannah M Reiland | General Practice | 8701 W Watertown Plank Rd, Department of Psychiatry and Behavioral Medicine, Milwaukee, WI 53226-3548 | 2017-03-28 |
| Find all providers in MILWAUKEE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.