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General NPI Number Information
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NPI Number | 1619258118
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Entity Type | Organization
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Legal Business Name | MIDWEST FAMILY WELLNESS, INC
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Dates
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Enumeration Date | 08/29/2011
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 840 W IRVING PARK RD SUITE 301
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City | CHICAGO
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State | IL
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Zip | 60613-3011
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Country | US
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Telephone | 773-975-3269
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Fax | 773-975-3270
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Provider Business Mailing Address
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Address Line | 840 W IRVING PARK RD SUITE 301
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City | CHICAGO
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State | IL
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Zip | 60613-3011
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Country | US
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Telephone | 773-975-3269
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Fax | 773-975-3270
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHERIE GILLEON
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Credential | D.O.
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Telephone | 773-975-3269
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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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