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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