Organization
ABRAHAM'S MARK COMPREHENSIVE WELLNESS CENTER, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICOLE D. KING MD (OWNER)
(773) 667-0768
Entity
Organization
Contact information
Practice address
9500 S DORCHESTER AVE, STE 100, CHICAGO, IL 60628-1700
(773) 667-0768
(773) 667-5529
Mailing address
PO BOX 13677, BELFAST, ME 04915-4027
(773) 667-0768
(773) 667-5529
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
036096686
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0061621
TRICARE
IL
01
—
1634166
BC/BS
IL
01
—
3474878
AETNA HMO
IL
01
—
7455146
CIGNA
IL
01
—
7779286
AETNA PPO
IL
01
—
DD6694
RAILRAOD MEDICARE
IL
Enumeration date
07/05/2006
Last updated
03/29/2026
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