Provider Demographics
NPI:1851927446
Name:WHOLEBODY VISITING PHYSICIANS
Entity Type:Organization
Organization Name:WHOLEBODY VISITING PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:NWAKA
Authorized Official - Last Name:WABONMOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-439-5003
Mailing Address - Street 1:7331 N LINCOLN AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1766
Mailing Address - Country:US
Mailing Address - Phone:855-346-1681
Mailing Address - Fax:224-251-8156
Practice Address - Street 1:17 E GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1099
Practice Address - Country:US
Practice Address - Phone:708-439-5003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty