Organization
ILLINOIS WELLNESS AND WEIGHT LOSS CENTERS SC
Active
Other names
None
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GOLDWYN B FOGGIE M.D. (CEO)
(708) 325-8616
Entity
Organization
Contact information
Practice address
9933 SOUTH WESTERN AVENUE, SUITE 200, CHICAGO, IL 60643-1810
(708) 325-8615
Mailing address
9933 SOUTH WESTERN AVENUE, SUITE 200, CHICAGO, IL 60643-1810
(708) 325-8615
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
—
—
207VB0002X
Obesity Medicine (Obstetrics & Gynecology) Physician
Primary
—
—
Other
Enumeration date
07/19/2016
Last updated
08/08/2023
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