MEDICARE: WESLEY R HARMSTON D.O.

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	207QA0505X	Adult Medicine Physician	036-124934	IL

General Provider Information

NPI Number	:	1821254475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WESLEY R HARMSTON D.O.

Provider Business Mailing Address
First Line	:	3232 W 55TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-2638
Country	:	US
Telephone Number	:	773-434-8026
Fax Number	:	773-434-8107

Provider Business Practice Location Address
First Line	:	3232 W 55TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-2638
Country	:	US
Telephone Number	:	773-434-8026
Fax Number	:	773-434-8107

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2008
Last Update Date	:	10/01/2015

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