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General NPI Number Information
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NPI Number | 1922300086
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL CENTER
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 52 N WOLF RD
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City | WHEELING
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State | IL
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Zip | 60090-2901
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Country | US
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Telephone | 847-465-0401
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Fax |
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Provider Business Mailing Address
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Address Line | 52 N WOLF RD
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City | WHEELING
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State | IL
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Zip | 60090-2901
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Country | US
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Telephone | 847-465-0401
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JORGE E. BRUNELLE
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Credential | M.D., M.P.H.
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Telephone | 847-465-0401
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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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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 36-097428
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License Number State | IL
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