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NPI Code Detail

MEDICARE: DR. JAMES WELLMAN

MEDICARE: DR. JAMES WELLMAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist071.008214IL

General Provider Information

NPI Number : 1255616140
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES WELLMAN
Provider Business Mailing Address
First Line : 3660 N LAKE SHORE DR STE 201
Second Line :
City : CHICAGO
State : IL
Zip : 60613-5302
Country : US
Telephone Number : 773-759-5126
Fax Number : 773-759-5126
Provider Business Practice Location Address
First Line : 3660 N LAKE SHORE DR STE 201
Second Line :
City : CHICAGO
State : IL
Zip : 60613-5302
Country : US
Telephone Number : 773-759-5126
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2011
Last Update Date : 12/10/2020

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