Healthcare Provider Details

I. General information

NPI: 1912942863
Provider Name (Legal Business Name): WINTERS FAMILY PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 ROYAL BLVD SUITE 300
ELGIN IL
60123-4719
US

IV. Provider business mailing address

2350 ROYAL BLVD SUITE 300
ELGIN IL
60123-4719
US

V. Phone/Fax

Practice location:
  • Phone: 847-742-3120
  • Fax: 847-742-4021
Mailing address:
  • Phone: 847-742-3120
  • Fax: 847-742-4021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number060000627
License Number StateIL

VIII. Authorized Official

Name: DR. GREGORY T WINTERS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-742-3120