Provider Demographics
NPI:1396832895
Name:FUNCTIONAL MEDICAL WELLNESS CENTER , LLC
Entity Type:Organization
Organization Name:FUNCTIONAL MEDICAL WELLNESS CENTER , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NADEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-562-0840
Mailing Address - Street 1:3100 DUNDEE RD STE 506
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2449
Mailing Address - Country:US
Mailing Address - Phone:847-562-0840
Mailing Address - Fax:847-562-0842
Practice Address - Street 1:3100 DUNDEE RD SUITE 506
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2402
Practice Address - Country:US
Practice Address - Phone:847-562-0840
Practice Address - Fax:847-562-0842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL364185349207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty