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General NPI Number Information
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NPI Number | 1073468989
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Entity Type | Organization
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Legal Business Name | LUMIN PSYCHIATRY & WELLNESS
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Dates
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Enumeration Date | 03/04/2026
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Last Update Date | 03/04/2026
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Provider Practice Location Address
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Address Line | 4150 N KENMORE AVE APT 404
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City | CHICAGO
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State | IL
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Zip | 60613-5971
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Country | US
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Telephone | 303-902-1536
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Fax |
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Provider Business Mailing Address
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Address Line | 4150 N KENMORE AVE APT 404
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City | CHICAGO
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State | IL
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Zip | 60613-5971
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Country | US
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Telephone | 303-902-1536
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Fax |
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Authorized Official
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Title or Position | FOUNDER/PHYSICIAN ASSISTANT
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Name | WESLEY GORDON
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Credential | PA-C
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Telephone | 303-902-1536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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