Basic Information
| Provider Information | |||||||||
| NPI: | 1881334373 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHICAGOLAND WELLMED CENTER SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4071 TEAK CIR | ||||||||
| Address2: | |||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605641104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147045959 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11933 S PULASKI RD STE C1 | ||||||||
| Address2: | |||||||||
| City: | ALSIP | ||||||||
| State: | IL | ||||||||
| PostalCode: | 608031100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083962500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2022 | ||||||||
| LastUpdateDate: | 03/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | VAUGHT | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3147045959 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
| NPICertificationDate: | 03/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.