Healthcare Provider Details

I. General information

NPI: 1053086629
Provider Name (Legal Business Name): O.O.N.MEDICAL GROUP LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2021
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 S WABASH AVE STE 250B
CHICAGO IL
60605-2355
US

IV. Provider business mailing address

1147 S WABASH AVE STE 250B
CHICAGO IL
60605-2355
US

V. Phone/Fax

Practice location:
  • Phone: 312-987-4878
  • Fax:
Mailing address:
  • Phone: 312-987-4878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: CHANELE SMITH
Title or Position: OFFICE MANAGER
Credential:
Phone: 239-970-2484