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Organization
MW WELLNESS XII, LLC
Active
Organization
MW WELLNESS XII, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY HEALD (EVP)
(813) 228-6334
Entity
Organization
Contact information
Practice address
154 FAUNCE CORNER RD, SUITE F, NORTH DARTMOUTH, MA 02747-1214
(813) 228-6334
Mailing address
509 S HYDE PARK AVE, TAMPA, FL 33606-2266
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207QB0002X
Obesity Medicine (Family Medicine) Physician
—
NULL
207QB0002X
Obesity Medicine (Family Medicine) Physician
—
—
Other
Enumeration date
02/18/2020
Last updated
02/18/2020
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