Healthcare Provider Details

I. General information

NPI: 1821288945
Provider Name (Legal Business Name): EXCEPTIONAL HEALTH PARTNERS, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 12/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N WALL ST SUITE 206
KANKAKEE IL
60901-2934
US

IV. Provider business mailing address

401 N WALL ST STE 206
KANKAKEE IL
60901-2934
US

V. Phone/Fax

Practice location:
  • Phone: 815-937-2044
  • Fax: 815-937-2029
Mailing address:
  • Phone: 815-937-2044
  • Fax: 815-937-2029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036068108
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036068108
License Number StateIL

VIII. Authorized Official

Name: MRS. ANNETTE WELLS
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 815-937-2044