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General NPI Number Information
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NPI Number | 1619650801
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Entity Type | Organization
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Legal Business Name | ONYX MEDICAL & WELLNESS PLLC
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 30 E 69TH ST
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City | CHICAGO
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State | IL
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Zip | 60637-4502
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Country | US
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Telephone | 773-865-3537
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Fax |
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Provider Business Mailing Address
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Address Line | 11301 S SAINT LAWRENCE AVE
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City | CHICAGO
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State | IL
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Zip | 60628-5111
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Country | US
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Telephone | 773-865-3537
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. MAYA GREEN
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Credential | MD
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Telephone | 773-865-3537
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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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