Provider Demographics
NPI:1912942863
Name:WINTERS FAMILY PRACTICE PC
Entity Type:Organization
Organization Name:WINTERS FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:T
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-742-3120
Mailing Address - Street 1:2350 ROYAL BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4719
Mailing Address - Country:US
Mailing Address - Phone:847-742-3120
Mailing Address - Fax:847-742-4021
Practice Address - Street 1:2350 ROYAL BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4719
Practice Address - Country:US
Practice Address - Phone:847-742-3120
Practice Address - Fax:847-742-4021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060000627207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty