Provider Demographics
NPI:1184331514
Name:WELLBE MEDICAL GROUP OF WEST VIRGINIA INC
Entity type:Organization
Organization Name:WELLBE MEDICAL GROUP OF WEST VIRGINIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:IYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-776-2415
Mailing Address - Street 1:225 W WASHINGTON ST STE 1500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-3485
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 1/2 D ST SUITE 3 SOUTH
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303
Practice Address - Country:US
Practice Address - Phone:855-997-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty