| Great Health Medical Wi Sc | |
|
1905 W Hart Rd Beloit WI 53511-2230 | |
| (718) 470-0288 | |
| Not Available |
| Full Name | Great Health Medical Wi Sc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1905 W Hart Rd, Beloit, Wisconsin |
| Authorized Official Name and Position | Azlan Tariq (OWNER) |
| Authorized Official Contact | 3127097238 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Health Medical Wi Sc 407 Willoughby Ave Brooklyn NY 11205-4590 Ph: () - | Great Health Medical Wi Sc 1905 W Hart Rd Beloit WI 53511-2230 Ph: (718) 470-0288 |
| NPI Number | 1326854829 |
|---|---|
| Provider Enumeration Date | 12/09/2024 |
| Last Update Date | 12/09/2024 |
| Medicare PECOS PAC ID | 4789112269 |
|---|---|
| Medicare Enrollment ID | O20250113000014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326854829 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Azlan Tariq |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1528291283 PECOS PAC ID: 1355504267 Enrollment ID: I20120511000315 |
| Provider Name | Tammy Rose Finley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427238336 PECOS PAC ID: 0042678591 Enrollment ID: I20230615001978 |
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