Provider Demographics
NPI:1306036439
Name:WELLBEINGMD, JOHN R. PRINCIPE MD, LTD
Entity Type:Organization
Organization Name:WELLBEINGMD, JOHN R. PRINCIPE MD, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-551-1097
Mailing Address - Street 1:11950 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1150
Mailing Address - Country:US
Mailing Address - Phone:708-448-9450
Mailing Address - Fax:
Practice Address - Street 1:11950 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1150
Practice Address - Country:US
Practice Address - Phone:708-448-9450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL606240Medicare PIN