Provider Demographics
NPI:1881063873
Name:HEALTHY MEDICAL, LLC
Entity type:Organization
Organization Name:HEALTHY MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER (OWNER)
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:AXIUM
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:708-769-4758
Mailing Address - Street 1:205 HIGHPOINT DR
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:IL
Mailing Address - Zip Code:60935-6160
Mailing Address - Country:US
Mailing Address - Phone:708-769-4758
Mailing Address - Fax:
Practice Address - Street 1:205 HIGHPOINT DR
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:IL
Practice Address - Zip Code:60935-6160
Practice Address - Country:US
Practice Address - Phone:708-769-4758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-19
Last Update Date:2015-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007967261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care