NPI 1336408517

Living Well Health Management INC

Organisation Exclusive Provider Organization Chicago, IL

Practice location

Address: 4150 S Berkeley Ave, Chicago, IL 60653-3010
Phone: (773) 285-9100
Fax: (773) 451-2770

Authorised official

Name: Ida M Dixon
Title: President
Phone: (773) 285-9100

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 209009287 (IL)

Other Exclusive Provider Organization providers in Illinois →

Registry record

NPI: 1336408517
Entity type: Organization
NPI issued: 9 May 2012
Record last updated: 9 May 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.