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General NPI Number Information
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NPI Number | 1083595482
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Entity Type | Organization
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Legal Business Name | TELES HEALTH MEDICAL GROUP PC
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Dates
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Enumeration Date | 09/11/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1049 E WILSON ST STE 170
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City | BATAVIA
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State | IL
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Zip | 60510-2478
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Country | US
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Telephone | 872-250-3732
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Fax |
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Provider Business Mailing Address
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Address Line | 980 N MICHIGAN AVE
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City | CHICAGO
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State | IL
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Zip | 60611-4501
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Country | US
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Telephone | 872-250-3732
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | MRS. BONITA VILLAR
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Credential | RN, MSN
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Telephone | 872-250-3732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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