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NPI Code Detail

MEDICARE: WELLGROUP HEALTHPARTNERS LLC

MEDICARE: WELLGROUP HEALTHPARTNERS 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
1261QA1903XAmbulatory Surgical Clinic/Center7002769IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17002769OTHERILLICENSE ID NUMBER

General Provider Information

NPI Number : 1699739896
Entity Type Code : Organization
Provider Name (Legal Business Name) : WELLGROUP HEALTHPARTNERS LLC
Provider Business Mailing Address
First Line : 333 DIXIE HWY
Second Line :
City : CHICAGO HEIGHTS
State : IL
Zip : 60411-1748
Country : US
Telephone Number : 708-754-4890
Fax Number : 708-709-6242
Provider Business Practice Location Address
First Line : 333 DIXIE HWY
Second Line :
City : CHICAGO HEIGHTS
State : IL
Zip : 60411-1748
Country : US
Telephone Number : 708-754-4890
Fax Number : 708-709-6242
Authorized Official
Title or Position : CEO
Name : DANIEL MCCORMICK
Credential :
Telephone Number : 708-756-0100
Provider Enumeration Date : 04/14/2006
Last Update Date : 08/22/2020

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Directions to “WELLGROUP HEALTHPARTNERS LLC ” Practice Location

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