Organization
ADVANCED WELLNESS CLINICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HELENE M RUIZ-PLA M.D, (PHYSICIAN)
(708) 450-0705
Entity
Organization
Contact information
Practice address
1835 N BROADWAY AVENUE, SUITE 104, MELROSE PARK, IL 60160
(708) 450-0705
Mailing address
1835 N BROADWAY AVENUE, SUITE 104, MELROSE PARK, IL 60160
(708) 450-0705
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036074432
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0031603786
BC BS
IL
05
—
036079717
—
IL
Enumeration date
01/13/2011
Last updated
01/13/2011
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