| Live Ignite Thrive Limited | |
|
15614 S Harlem Ave Ste C Orland Park IL 60462-4401 | |
| (708) 866-5900 | |
| (708) 866-5903 |
| Full Name | Live Ignite Thrive Limited |
|---|---|
| Speciality | Clinic/Center |
| Location | 15614 S Harlem Ave Ste C, Orland Park, Illinois |
| Authorized Official Name and Position | Adam Weldzius (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8474526533 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Live Ignite Thrive Limited 2345 E Offner Rd Beecher IL 60401-3784 Ph: (847) 452-6533 | Live Ignite Thrive Limited 15614 S Harlem Ave Ste C Orland Park IL 60462-4401 Ph: (708) 866-5900 |
| NPI Number | 1184221004 |
|---|---|
| Provider Enumeration Date | 10/04/2020 |
| Last Update Date | 09/02/2021 |
| Medicare PECOS PAC ID | 2860805801 |
|---|---|
| Medicare Enrollment ID | O20210112000074 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184221004 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Adam J Weldzius |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477793792 PECOS PAC ID: 0345385480 Enrollment ID: I20100301000838 |
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