MEDICARE: COMPREHENSIVE WELLNESS CARE LLC

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
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1427361344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE WELLNESS CARE LLC

Provider Business Mailing Address
First Line	:	2825 N HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5105
Country	:	US
Telephone Number	:	773-549-8900
Fax Number	:	773-549-8511

Provider Business Practice Location Address
First Line	:	2825 N HALSTED ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5105
Country	:	US
Telephone Number	:	773-549-8900
Fax Number	:	773-549-8511

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. TERESA HUBKA
Credential	:	DO
Telephone Number	:	773-549-8900

Provider Enumeration Date	:	07/20/2010
Last Update Date	:	06/22/2011

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