Well Kept Elder Enterprises, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WELL KEPT ELDER ENTERPRISES, LLC

Practice address

558 W Roosevelt Rd # 3
Chicago, IL 60607-4917

Phone

(773) 358-8295

Fax

(312) 872-3562

NPI assigned

Jul 22, 2019

Organization subpart

No

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

Authorized official

Name

Monica Shalise' Buckner

Title

Owner Physician

Phone

(773) 358-8295

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Well Kept Elder Enterprises, LLC Doing business as

Locations

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

{
    "created_epoch": "1563753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693785600000",
    "number": "1508419367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "558 W ROOSEVELT RD # 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606074917",
            "telephone_number": "773-358-8295",
            "fax_number": "312-872-3562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "558 W ROOSEVELT RD # 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606074917",
            "telephone_number": "773-358-8295",
            "fax_number": "312-872-3562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELL KEPT ELDER ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-22",
        "last_updated": "2023-09-04",
        "certification_date": "2023-09-04",
        "status": "A",
        "authorized_official_last_name": "BUCKNER",
        "authorized_official_first_name": "MONICA",
        "authorized_official_middle_name": "SHALISE'",
        "authorized_official_title_or_position": "OWNER PHYSICIAN",
        "authorized_official_telephone_number": "773-358-8295"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125067381",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Well Kept Elder Enterprises, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Well Kept Elder Enterprises, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2023; 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.