Provider Demographics
NPI:1619258118
Name:MIDWEST FAMILY WELLNESS, INC
Entity Type:Organization
Organization Name:MIDWEST FAMILY WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLEON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:773-975-3269
Mailing Address - Street 1:840 W IRVING PARK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3011
Mailing Address - Country:US
Mailing Address - Phone:773-975-3269
Mailing Address - Fax:773-975-3270
Practice Address - Street 1:840 W IRVING PARK RD
Practice Address - Street 2:SUITE 301
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3011
Practice Address - Country:US
Practice Address - Phone:773-975-3269
Practice Address - Fax:773-975-3270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty