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Organization

AGELESS WELLNESS CENTER, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ABDULLATTIEF A SULIEMAN MD (PRESIDENT/OWNER)
(414) 475-5800
Entity
Organization

Contact information

Practice address
2745 W LAYTON AVE, SUITE 203, MILWAUKEE, WI 53221-2651
(414) 475-5800
(414) 475-5400
Mailing address
PO BOX 639, THIENSVILLE, WI 53092-0639
(414) 247-9005
(414) 247-9004

Taxonomy

Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
51008
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1881864197
WI
01
K100110473
MEDICARE
WI
Enumeration date
07/24/2013
Last updated
05/02/2014
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