Provider Demographics
NPI:1497024616
Name:PHYSICIAN ON WHEELS
Entity Type:Organization
Organization Name:PHYSICIAN ON WHEELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ACQUAYE-AWAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-807-0555
Mailing Address - Street 1:PO BOX 7151
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-7151
Mailing Address - Country:US
Mailing Address - Phone:773-807-0555
Mailing Address - Fax:
Practice Address - Street 1:501 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3045
Practice Address - Country:US
Practice Address - Phone:773-807-0555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102126207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty