MEDICARE: RJB MEDICAL WELLNESS ASSOCIATES INC

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	207QB0002X	Obesity Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1699057265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RJB MEDICAL WELLNESS ASSOCIATES INC

Provider Business Mailing Address
First Line	:	4550 W SOUTHWEST HIGHWAY
Second Line	:
City	:	OAKLAWN
State	:	IL
Zip	:	60453-1842
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4550 W SOUTHWEST HIGHWAY
Second Line	:
City	:	OAKLAWN
State	:	IL
Zip	:	60453-1842
Country	:	US
Telephone Number	:	708-422-7173
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT BRUNO
Credential	:	MD
Telephone Number	:	708-422-7173

Provider Enumeration Date	:	09/09/2011
Last Update Date	:	09/09/2011

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