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General NPI Number Information
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NPI Number | 1659657252
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Entity Type | Organization
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Legal Business Name | WHOLE LIFE CENTER INC
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 48 E 31ST ST
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City | LA GRANGE PARK
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State | IL
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Zip | 60526-1024
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Country | US
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Telephone | 708-352-7212
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Fax | 708-352-7228
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Provider Business Mailing Address
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Address Line | 48 E 31ST ST
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City | LA GRANGE PARK
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State | IL
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Zip | 60526-1024
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Country | US
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Telephone | 708-352-7212
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Fax | 708-352-7228
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Authorized Official
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Title or Position | DIRECTOR
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Name | LORENE Y. WU
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Credential | M.D.
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Telephone | 708-352-7212
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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 | 036089752
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License Number State | IL
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