Healthcare Provider Details

I. General information

NPI: 1689405078
Provider Name (Legal Business Name): INTEGRITY MEDICAL AND WOUNDS GROUP IL RLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 W BRYN MAWR AVE # 8700
CHICAGO IL
60631-3579
US

IV. Provider business mailing address

8770 W BRYN MAWR AVE STE 1300
CHICAGO IL
60631-3557
US

V. Phone/Fax

Practice location:
  • Phone: 702-580-7997
  • Fax:
Mailing address:
  • Phone: 702-580-7997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE GARALDE WALKER
Title or Position: OWNER
Credential:
Phone: 702-580-7997