ABRAHAM'S MARK COMPREHENSIVE WELLNESS CENTER SC NPI 1104857341

NPI Information

ABRAHAM'S MARK COMPREHENSIVE WELLNESS CENTER, SC is a primary care clinic center in Chicago, IL. ABRAHAM'S MARK COMPREHENSIVE WELLNESS CENTER, SC NPI is 1104857341. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

9500 S DORCHESTER AVE
STE 100
CHICAGO, IL
ZIP 60628-700
Phone: (773) 667-0768
Fax: (773) 667-5529

The provider's authorized official is Nicole D. King .
The authorized official title is Owner and has the following contact phone number (773) 667-0768.

The CLIA number assigned to this NPI record is 14D0983271 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/5/2006 and was last updated on 12/3/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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