| Abraham's Mark Comprehensive Wellness Center, Sc | |
|
9500 S Dorchester Ave Ste 100 Chicago IL 60628-1700 | |
| (773) 667-0768 | |
| (773) 667-5529 |
| Full Name | Abraham's Mark Comprehensive Wellness Center, Sc |
|---|---|
| Speciality | Clinic/Center |
| Location | 9500 S Dorchester Ave, Chicago, Illinois |
| Authorized Official Name and Position | Nicole D. King (OWNER) |
| Authorized Official Contact | 7736670768 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Abraham's Mark Comprehensive Wellness Center, Sc Po Box 13677 Belfast ME 04915-4027 Ph: (773) 667-0768 | Abraham's Mark Comprehensive Wellness Center, Sc 9500 S Dorchester Ave Ste 100 Chicago IL 60628-1700 Ph: (773) 667-0768 |
| NPI Number | 1104857341 |
|---|---|
| Provider Enumeration Date | 07/05/2006 |
| Last Update Date | 12/03/2020 |
| Medicare PECOS PAC ID | 4688663743 |
|---|---|
| Medicare Enrollment ID | O20040512000597 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104857341 | NPI | - | NPPES |
| 1634166 | Other | IL | BC/BS |
| 7455146 | Other | IL | CIGNA |
| 7779286 | Other | IL | AETNA PPO |
| 0061621 | Other | IL | TRICARE |
| 3474878 | Other | IL | AETNA HMO |
| DD6694 | Other | IL | RAILRAOD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | 036096686 (Illinois) | Primary |
| Provider Name | Nicole D King |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558334003 PECOS PAC ID: 7911996079 Enrollment ID: I20040512000647 |
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