| Organization Name: | AGELESS WELLNESS CENTER, INC |
| NPI Number: | 1245672856 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ABDULLATTIEF A SULIEMAN (PRESIDENT/OWNER) |
| Mailing Address: | 2745 W Layton Ave Suite 203 Milwaukee |
| State: | WI US |
| Postal Code: | 532212651 |
| Phone Number: | 4144755800 |
| Fax Number: | 4144755400 |
| NPI Enumeration Date: | 07/24/2013 |
| NPI Last Update Date: | 05/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 51008 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |