MEDICARE: LUMIN PSYCHIATRY & WELLNESS

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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1073468989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMIN PSYCHIATRY & WELLNESS

Provider Business Mailing Address
First Line	:	4150 N KENMORE AVE APT 404
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5971
Country	:	US
Telephone Number	:	303-902-1536
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 N KENMORE AVE APT 404
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5971
Country	:	US
Telephone Number	:	303-902-1536
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/PHYSICIAN ASSISTANT
Name	:	WESLEY GORDON
Credential	:	PA-C
Telephone Number	:	303-902-1536

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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