# FLORENCE WELLNESS OF ILLINOIS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255063533
- **Authorized official:** JACOB HALPERT (SECRETARY)
- **Authorized official phone:** (202) 893-7910

## Contact information

- **Practice address:** 515 N STATE ST, CHICAGO, IL 60654-4854
- **Practice address phone:** (202) 893-7910
- **Mailing address:** 515 N STATE ST, CHICAGO, IL 60654-4854

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/27/2022
- **Last updated:** 06/27/2022