Provider Demographics
NPI:1982389375
Name:OAKWELL ILLINOIS PHYSICIANS PLLC
Entity Type:Organization
Organization Name:OAKWELL ILLINOIS PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:GRIFFIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-264-2085
Mailing Address - Street 1:2601 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2100
Mailing Address - Country:US
Mailing Address - Phone:708-484-7300
Mailing Address - Fax:708-484-6185
Practice Address - Street 1:2601 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2100
Practice Address - Country:US
Practice Address - Phone:708-484-7300
Practice Address - Fax:708-484-6185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty