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General NPI Number Information
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NPI Number | 1104136100
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Entity Type | Organization
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Legal Business Name | WELL INTEGRATIVE FAMILY MEDICINE, INC.
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Dates
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Enumeration Date | 10/12/2010
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Last Update Date | 10/22/2010
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Provider Practice Location Address
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Address Line | 1945 W WILSON AVE 6106
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City | CHICAGO
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State | IL
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Zip | 60640-5255
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Country | US
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Telephone | 773-784-7000
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Fax | 773-784-7190
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Provider Business Mailing Address
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Address Line | 1945 W WILSON AVE 6106
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City | CHICAGO
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State | IL
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Zip | 60640-5255
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Country | US
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Telephone | 773-784-7000
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Fax | 773-784-7190
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Authorized Official
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Title or Position | PRESIDENT/MEDICAL DIRECTOR
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Name | DR. AMY S WEILER
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Credential | D.O.
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Telephone | 773-784-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036117858
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License Number State | IL
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