MEDICARE: O.O.N.MEDICAL GROUP LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1053086629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	O.O.N.MEDICAL GROUP LTD

Provider Business Mailing Address
First Line	:	1147 S WABASH AVE STE 250B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2355
Country	:	US
Telephone Number	:	312-987-4878
Fax Number	:	239-228-8640

Provider Business Practice Location Address
First Line	:	1147 S WABASH AVE STE 250B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2355
Country	:	US
Telephone Number	:	312-987-4878
Fax Number	:	239-228-8640

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CHANELE SMITH
Credential	:
Telephone Number	:	239-260-0530

Provider Enumeration Date	:	08/15/2021
Last Update Date	:	06/04/2026

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