Organization
HOOSIER WELLNESS PROVIDERS, LLC
Active
Organization
HOOSIER WELLNESS PROVIDERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIRILL VESSELOV (MANAGER)
(561) 461-3791
Entity
Organization
Contact information
Practice address
637 S WALKER ST, BLOOMINGTON, IN 47403-2176
(561) 461-3791
Mailing address
2925 10TH AVE N, PALM SPRINGS, FL 33461-3000
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1467936070
DAWN JOHNSON
IN
01
—
1497891840
MICHAEL KANE
IN
Enumeration date
05/18/2021
Last updated
01/19/2026
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