Organization
SPECIALTY PHYSICIANS OF ILLINOIS, LLC
Active
Organization
SPECIALTY PHYSICIANS OF ILLINOIS, LLC
Active
Other names
WellGroup Health Partners, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA PHALEN (DIRECTOR)
(219) 554-4548
Entity
Organization
Contact information
Practice address
1040 SIERRA DR STE 400, GREENWOOD, IN 46143-7241
(317) 528-4291
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
—
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207U00000X
Nuclear Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207W00000X
Ophthalmology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
—
2084N0400X
Neurology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
203979
MEDICARE PTAN
IL
Enumeration date
05/30/2006
Last updated
02/15/2023
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