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General NPI Number Information
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NPI Number | 1548033426
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Entity Type | Organization
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Legal Business Name | APEX WELLNESS LLC
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Dates
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Enumeration Date | 11/02/2023
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 1370 W WALTON ST APT 1W
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City | CHICAGO
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State | IL
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Zip | 60642-5627
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Country | US
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Telephone | 312-339-5010
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Fax |
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Provider Business Mailing Address
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Address Line | 1370 W WALTON ST APT 1W
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City | CHICAGO
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State | IL
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Zip | 60642-5627
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | JUSTIN BALLARD
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Credential |
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Telephone | 312-999-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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