Provider Demographics
NPI:1003848326
Name:HARMONY MEDICAL AND WELLNESS CENTER INC
Entity Type:Organization
Organization Name:HARMONY MEDICAL AND WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:MO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-989-1885
Mailing Address - Street 1:4600 N MAGNOLIA AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5083
Mailing Address - Country:US
Mailing Address - Phone:773-989-1885
Mailing Address - Fax:773-989-9828
Practice Address - Street 1:4600 N MAGNOLIA
Practice Address - Street 2:HARMONY MEDICAL AND WELLNESS CENTER SUITE D
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:773-989-1885
Practice Address - Fax:773-989-9828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036048011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036048011Medicaid
C42002Medicare UPIN
IL036048011Medicaid