NPIMap

Organization Active NPI

Midwest Institute for Wellness LLC

  • Internal Medicine Physician
  • Deer Park, IL
National Provider Identifier
1295165751
Registry record updated Nov 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036-119123
Legal business name
MIDWEST INSTITUTE FOR WELLNESS LLC
Practice address
21720 W Long Grove Rd
Ste 246
Deer Park, IL 60010-3732
Phone
(847) 309-7012
NPI assigned
Nov 20, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bino Oommen, M.D.
Title
Physician
Phone
(847) 309-7012

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 036-119123 Primary

Addresses

Primary practice location

21720 W Long Grove Rd
Ste 246
Deer Park, IL 60010-3732

Mailing address

21720 W Long Grove Rd
Ste 246
Deer Park, IL 60010-3732
Phone (847) 309-7012

National Provider Directory

National Provider Directory

Locations

350 W Kensington Rd
Ste 109
Mt Prospect, IL 60056

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1384905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384905600000",
    "number": "1295165751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21720 W LONG GROVE RD",
            "address_2": "STE 246",
            "city": "DEER PARK",
            "state": "IL",
            "postal_code": "600103732",
            "telephone_number": "847-309-7012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21720 W LONG GROVE RD",
            "address_2": "STE 246",
            "city": "DEER PARK",
            "state": "IL",
            "postal_code": "600103732",
            "telephone_number": "847-309-7012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST INSTITUTE FOR WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-20",
        "last_updated": "2013-11-20",
        "status": "A",
        "authorized_official_last_name": "OOMMEN",
        "authorized_official_first_name": "BINO",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "847-309-7012",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": "036-119123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deer Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.