MEDICARE: WELL SPRING FAMILY PHYSICIANS, 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	207Q00000X	Family Medicine Physician		IL

General Provider Information

NPI Number	:	1639248883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELL SPRING FAMILY PHYSICIANS, LLC

Provider Business Mailing Address
First Line	:	1049 E WILSON ST
Second Line	:	SUITE 160 B
City	:	BATAVIA
State	:	IL
Zip	:	60510-2474
Country	:	US
Telephone Number	:	630-232-2766
Fax Number	:	630-232-2099

Provider Business Practice Location Address
First Line	:	1049 E WILSON ST
Second Line	:	SUITE 160 B
City	:	BATAVIA
State	:	IL
Zip	:	60510-2474
Country	:	US
Telephone Number	:	630-232-2766
Fax Number	:	630-232-2099

Authorized Official
Title or Position	:	DOCTOR
Name	:	EBRAHIM AMANI
Credential	:	M.D.
Telephone Number	:	630-232-2766

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	08/22/2020

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