| Wholebody Visiting Physicians | |
|
17 E Grandview Dr South Holland IL 60473-1099 | |
| (708) 439-5003 | |
| Not Available |
| Full Name | Wholebody Visiting Physicians |
|---|---|
| Speciality | Family Medicine |
| Location | 17 E Grandview Dr, South Holland, Illinois |
| Authorized Official Name and Position | Grace Nwaka Wabonmor (PRESIDENT) |
| Authorized Official Contact | 7084395003 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wholebody Visiting Physicians 7331 N Lincoln Ave Ste 15 Lincolnwood IL 60712-1766 Ph: (855) 346-1681 | Wholebody Visiting Physicians 17 E Grandview Dr South Holland IL 60473-1099 Ph: (708) 439-5003 |
| NPI Number | 1851927446 |
|---|---|
| Provider Enumeration Date | 03/16/2020 |
| Last Update Date | 03/16/2020 |
| Medicare PECOS PAC ID | 3678992872 |
|---|---|
| Medicare Enrollment ID | O20201007000464 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851927446 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Grace Nwaka Wabomnor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548725799 PECOS PAC ID: 0042552200 Enrollment ID: I20190508002619 |
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