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General NPI Number Information
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NPI Number | 1578488755
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Entity Type | Organization
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Legal Business Name | 360 MEDICAL GROUP ILLINOIS P.C.
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Dates
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Enumeration Date | 08/13/2026
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Last Update Date | 08/13/2026
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Provider Practice Location Address
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Address Line | 31 W DUNDEE RD
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City | WHEELING
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State | IL
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Zip | 60090-4863
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Country | US
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Telephone | 833-360-6338
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD STE N
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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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 | ADMINISTRATOR
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Name | JAMES VILLAR
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Credential |
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Telephone | 833-360-6338
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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 |
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License Number State |
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