Provider Demographics
NPI:1417034034
Name:FAMILY MEDICINE & WELLNESS CENTER, P.C.
Entity Type:Organization
Organization Name:FAMILY MEDICINE & WELLNESS CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIEDU
Authorized Official - Middle Name:
Authorized Official - Last Name:NCHEKWUBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-985-5500
Mailing Address - Street 1:5495 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-1647
Mailing Address - Country:US
Mailing Address - Phone:219-985-5500
Mailing Address - Fax:219-985-5510
Practice Address - Street 1:5495 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-1647
Practice Address - Country:US
Practice Address - Phone:219-985-5500
Practice Address - Fax:219-985-5510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031281A251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200229460Medicaid
IN200229460Medicaid
IN876090Medicare PIN