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NPI Code Detail

MEDICARE: DR. GREGORY WELLS M.D.

MEDICARE: DR. GREGORY WELLS M.D.
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
1207L00000XAnesthesiology Physician036069236IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376771576
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY WELLS M.D.
Provider Business Mailing Address
First Line : 3412 W FULLERTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-2416
Country : US
Telephone Number : 773-235-8000
Fax Number :
Provider Business Practice Location Address
First Line : 3412 W FULLERTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-2416
Country : US
Telephone Number : 773-235-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2009
Last Update Date : 06/25/2009

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Directions to “ DR. GREGORY WELLS M.D.” Practice Location

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