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General NPI Number Information
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NPI Number | 1114357811
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Entity Type | Organization
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Legal Business Name | WELLNESS INTEGRATIVE MEDICINE, INC
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Dates
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Enumeration Date | 11/15/2013
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Last Update Date | 07/22/2016
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Provider Practice Location Address
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Address Line | 18036 GOTTSCHALK AVE
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City | HOMEWOOD
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State | IL
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Zip | 60430-1712
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Country | US
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Telephone | 708-960-2986
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Fax | 855-869-8599
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Provider Business Mailing Address
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Address Line | 18036 GOTTSCHALK AVE
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City | HOMEWOOD
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State | IL
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Zip | 60430-1712
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Country | US
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Telephone | 708-960-2986
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Fax | 855-869-8599
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Authorized Official
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Title or Position | OWNER
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Name | DR. RUSHIA BUTLER
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Credential | MD
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Telephone | 708-960-2986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036103914
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License Number State | IL
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