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General NPI Number Information
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NPI Number | 1639248883
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Entity Type | Organization
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Legal Business Name | WELL SPRING FAMILY PHYSICIANS, LLC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1049 E WILSON ST SUITE 160 B
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City | BATAVIA
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State | IL
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Zip | 60510-2474
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Country | US
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Telephone | 630-232-2766
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Fax | 630-232-2099
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Provider Business Mailing Address
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Address Line | 1049 E WILSON ST SUITE 160 B
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City | BATAVIA
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State | IL
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Zip | 60510-2474
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Country | US
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Telephone | 630-232-2766
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Fax | 630-232-2099
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Authorized Official
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Title or Position | DOCTOR
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Name | EBRAHIM AMANI
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Credential | M.D.
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Telephone | 630-232-2766
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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 | IL
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