| Wilkes Wellness Services Inc | |
|
400 W 76th St Ste 303 Chicago IL 60620-1640 | |
| (773) 536-9922 | |
| Not Available |
| Full Name | Wilkes Wellness Services Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 400 W 76th St Ste 303, Chicago, Illinois |
| Authorized Official Name and Position | Larry Wilkes (CEO) |
| Authorized Official Contact | 7735369922 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wilkes Wellness Services Inc 400 W 76th St Ste 303 Chicago IL 60620-1640 Ph: (773) 536-9922 | Wilkes Wellness Services Inc 400 W 76th St Ste 303 Chicago IL 60620-1640 Ph: (773) 536-9922 |
| NPI Number | 1629577986 |
|---|---|
| Provider Enumeration Date | 02/01/2018 |
| Last Update Date | 03/25/2023 |
| Certification Date | 03/25/2023 |
| Medicare PECOS PAC ID | 1850636184 |
|---|---|
| Medicare Enrollment ID | O20181214001033 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629577986 | NPI | - | NPPES |
| Provider Name | Jordan D Grumet |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1093887705 PECOS PAC ID: 0749211746 Enrollment ID: I20050830000412 |
| Provider Name | Marlyn D Hirsch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386824597 PECOS PAC ID: 9739266479 Enrollment ID: I20080407000017 |
| Provider Name | Larry L Wilkes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942623525 PECOS PAC ID: 4284856204 Enrollment ID: I20141106001857 |
| Provider Name | Kionie T Abraham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063897288 PECOS PAC ID: 5193030377 Enrollment ID: I20150817002815 |
| Provider Name | Talia Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336502681 PECOS PAC ID: 7416246152 Enrollment ID: I20160518002536 |
| Provider Name | Jannele Rowe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508415241 PECOS PAC ID: 4486083862 Enrollment ID: I20200406002753 |
| Provider Name | Latonya Robinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891340295 PECOS PAC ID: 8820427149 Enrollment ID: I20200407001759 |
| Provider Name | Rasheda Renee Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588127740 PECOS PAC ID: 6800203605 Enrollment ID: I20210323001244 |
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