| Well Kept Elder Enterprises, Llc | |
|
558 W Roosevelt Rd # 3 Chicago IL 60607-4917 | |
| (773) 358-8295 | |
| (312) 872-3562 |
| Full Name | Well Kept Elder Enterprises, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 558 W Roosevelt Rd # 3, Chicago, Illinois |
| Authorized Official Name and Position | Monica Shalise' Buckner (OWNER PHYSICIAN) |
| Authorized Official Contact | 7733588295 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Well Kept Elder Enterprises, Llc 558 W Roosevelt Rd # 3 Chicago IL 60607-4917 Ph: (773) 358-8295 | Well Kept Elder Enterprises, Llc 558 W Roosevelt Rd # 3 Chicago IL 60607-4917 Ph: (773) 358-8295 |
| NPI Number | 1508419367 |
|---|---|
| Provider Enumeration Date | 07/22/2019 |
| Last Update Date | 09/04/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508419367 | NPI | - | NPPES |
| 125067381 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Secondary |
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