| Wellness Medical Center Llc | |
|
8937 W Golf Rd Niles IL 60714-5812 | |
| (248) 842-9353 | |
| Not Available |
| Full Name | Wellness Medical Center Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 8937 W Golf Rd, Niles, Illinois |
| Authorized Official Name and Position | Olena Gordon (OWNER/ PHYSICIAN) |
| Authorized Official Contact | 8473759711 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellness Medical Center Llc 8937 W Golf Rd Niles IL 60714-5812 Ph: () - | Wellness Medical Center Llc 8937 W Golf Rd Niles IL 60714-5812 Ph: (248) 842-9353 |
| NPI Number | 1609336627 |
|---|---|
| Provider Enumeration Date | 03/25/2019 |
| Last Update Date | 12/18/2019 |
| Medicare PECOS PAC ID | 5991047896 |
|---|---|
| Medicare Enrollment ID | O20190424002515 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609336627 | NPI | - | NPPES |
| 036131766 | Medicaid | IL | |
| F100554988 | Other | IL | MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QP2000X | Clinic/center - Physical Therapy | (* (Not Available)) | Secondary |
| Provider Name | Olena Gordon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1528309705 PECOS PAC ID: 7618101924 Enrollment ID: I20130927000388 |
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