Organization
ILLINOIS WELLNESS AND WEIGHT LOSS CENTERS SC
Active
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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