MEDICARE: VILLAGE INTERNAL MEDICINE, 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	207R00000X	Internal Medicine Physician		IL

General Provider Information

NPI Number	:	1881890218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VILLAGE INTERNAL MEDICINE, LTD

Provider Business Mailing Address
First Line	:	700 OAK ST
Second Line	:	SUITE 200
City	:	WINNETKA
State	:	IL
Zip	:	60093
Country	:	US
Telephone Number	:	847-446-1066
Fax Number	:	847-446-1825

Provider Business Practice Location Address
First Line	:	700 OAK ST
Second Line	:	SUITE 200
City	:	WINNETKA
State	:	IL
Zip	:	60093-2566
Country	:	US
Telephone Number	:	847-446-1066
Fax Number	:	847-446-1825

Authorized Official
Title or Position	:	BUSINESS AND OFFICE MANAGER
Name	:	MR. JOHN M WEDELL
Credential	:
Telephone Number	:	847-446-1066

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	08/22/2020

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