Provider Demographics
NPI:1093187239
Name:PREVENTIVE CARDIOVASCULAR SERVICES & HEALTH SERVICES
Entity Type:Organization
Organization Name:PREVENTIVE CARDIOVASCULAR SERVICES & HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER ACUPUNCTURE & NUTRITION
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WICKS, MSC MD MBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD MBA MSC LAC
Authorized Official - Phone:312-933-5204
Mailing Address - Street 1:356 W SUPERIOR ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60654-3416
Mailing Address - Country:US
Mailing Address - Phone:312-933-5204
Mailing Address - Fax:
Practice Address - Street 1:4800 S CHICAGO BEACH DR APT 311S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-7019
Practice Address - Country:US
Practice Address - Phone:312-933-5204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty