Organization
JMJ3 HERITAGE, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NAOMI CHELLI MD (ORGANIZER)
(563) 508-5139
Entity
Organization
Contact information
Practice address
3800 COMMERCE BLVD, DAVENPORT, IA 52807-3495
(563) 322-1888
Mailing address
3135 52ND AVENUE CT, BETTENDORF, IA 52722-6953
(563) 508-5139
(563) 359-3828
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
35355
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036111692
ILLINOIS LICENSE
IL
01
—
35355
IOWA LICENSE
IA
Enumeration date
01/02/2014
Last updated
01/02/2014
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