California Devon Medical Center
General Practice in Wheeling, IL. Organization (NPI-2).
NPI number1639375637
StatusActive
Last updated in NPPESOct 2, 2007
Details
- NPI
- 1639375637
- Entity type
- Organization (NPI-2)
- Legal business name
- California Devon Medical Center
- Organization subpart
- No
- Enumeration date
- Jun 26, 2007
- Last updated
- Oct 2, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208D00000X | General Practice | 036-118777 | IL | Yes |
| 111N00000X | Chiropractor | 038-010375 | IL | |
| 207Q00000X | Family Medicine | 036-116850 | IL | |
| 207R00000X | Internal Medicine | 036-062524 | IL | |
| 207RE0101X | Internal Medicine, Endocrinology, Diabetes & Metabolism | 036-115321 | IL | |
| 2081P2900X | Physical Medicine & Rehabilitation, Pain Medicine | 036-110569 | IL | |
| 207Q00000X | Family Medicine | 036.106058 | IL |
Other names
- Healthy Trust Immediate Medical Center (Doing Business As)
Practice location
342 South Milwaukee Ave.Wheeling, IL 60090
Phone 847-520-8909 · Fax 847-520-8929
Mailing address
342 South Milwaukee Ave.Wheeling, IL 60090
Phone 847-520-8909 · Fax 847-520-8929
Authorized official
Boris Gurevich
Medical Director
8475208909
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