Provider Demographics
NPI:1821342312
Name:IWELLMAX, LLC
Entity Type:Organization
Organization Name:IWELLMAX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-321-2611
Mailing Address - Street 1:1300 HIGGINS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5766
Mailing Address - Country:US
Mailing Address - Phone:773-321-2611
Mailing Address - Fax:773-321-2811
Practice Address - Street 1:1300 HIGGINS RD STE 200
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-5766
Practice Address - Country:US
Practice Address - Phone:773-321-2611
Practice Address - Fax:773-321-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty