Provider Demographics
NPI:1104136100
Name:WELL INTEGRATIVE FAMILY MEDICINE, INC.
Entity type:Organization
Organization Name:WELL INTEGRATIVE FAMILY MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEILER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:773-784-7000
Mailing Address - Street 1:1945 W WILSON AVE
Mailing Address - Street 2:6106
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5255
Mailing Address - Country:US
Mailing Address - Phone:773-784-7000
Mailing Address - Fax:773-784-7190
Practice Address - Street 1:1945 W WILSON AVE
Practice Address - Street 2:6106
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5255
Practice Address - Country:US
Practice Address - Phone:773-784-7000
Practice Address - Fax:773-784-7190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-12
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty