| Family Wellness Clinic Ltd | |
|
410 E Northwest Hwy Mount Prospect IL 60056-3305 | |
| (847) 632-1680 | |
| (847) 632-1681 |
| Full Name | Family Wellness Clinic Ltd |
|---|---|
| Speciality | Family Medicine |
| Location | 410 E Northwest Hwy, Mount Prospect, Illinois |
| Authorized Official Name and Position | Raymond Gomez (DIRECT OWNER) |
| Authorized Official Contact | 8476321680 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Wellness Clinic Ltd 410 E Northwest Hwy Mount Prospect IL 60056-3305 Ph: (847) 632-1680 | Family Wellness Clinic Ltd 410 E Northwest Hwy Mount Prospect IL 60056-3305 Ph: (847) 632-1680 |
| NPI Number | 1083763866 |
|---|---|
| Provider Enumeration Date | 01/09/2007 |
| Last Update Date | 09/26/2022 |
| Medicare PECOS PAC ID | 6800889445 |
|---|---|
| Medicare Enrollment ID | O20040407001355 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083763866 | NPI | - | NPPES |
| 036101711 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036101711 (Illinois) | Primary |
| Provider Name | Raymond Gomez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598784829 PECOS PAC ID: 1850384223 Enrollment ID: I20040403000289 |
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