Organization
DEJEAN WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDRE T DEJEAN MD (PHYSICIAN)
(773) 962-4672
Entity
Organization
Contact information
Practice address
326 W 64TH ST, SUITE 5, CHICAGO, IL 60621-3114
(773) 962-4672
Mailing address
326 W 64TH ST, SUITE 5, CHICAGO, IL 60621-3114
(773) 962-4672
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036098445
—
IL
Enumeration date
08/24/2009
Last updated
08/24/2009
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