MEDICARE: APEX WELLNESS LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1548033426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APEX WELLNESS LLC

Provider Business Mailing Address
First Line	:	1370 W WALTON ST APT 1W
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-5627
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1370 W WALTON ST APT 1W
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-5627
Country	:	US
Telephone Number	:	312-339-5010
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	JUSTIN BALLARD
Credential	:
Telephone Number	:	312-999-9999

Provider Enumeration Date	:	11/02/2023
Last Update Date	:	11/21/2023

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Directions to “APEX WELLNESS LLC ” Practice Location

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