Functional Fitness of Dupage, Inc

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

FUNCTIONAL FITNESS OF DUPAGE, INC

Practice address

27W157 Walnut Dr
Winfield, IL 60190-2051

Phone

(630) 390-8417

NPI assigned

Nov 9, 2018

Organization subpart

No

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

Authorized official

Name

Tanner Shultz, MS, CSCSNPI 1629551312

Title

Clinical Exercise Physiologist

Phone

(630) 390-8417

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tanner Shultz

  • Clinical Exercise Physiologist
  • Winfield, IL
  • NPI 1629551312
  NPD (past) Authorized official

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

{
    "created_epoch": "1541721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541721600000",
    "number": "1861960601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27W157 WALNUT DR",
            "city": "WINFIELD",
            "state": "IL",
            "postal_code": "601902051",
            "telephone_number": "630-390-8417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27W157 WALNUT DR",
            "city": "WINFIELD",
            "state": "IL",
            "postal_code": "601902051",
            "telephone_number": "630-390-8417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL FITNESS OF DUPAGE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-09",
        "last_updated": "2018-11-09",
        "status": "A",
        "authorized_official_last_name": "SHULTZ",
        "authorized_official_first_name": "TANNER",
        "authorized_official_title_or_position": "CLINICAL EXERCISE PHYSIOLOGIST",
        "authorized_official_telephone_number": "630-390-8417",
        "authorized_official_credential": "MS, CSCS"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Jane Fredrickson, MD
• Jeana L Friday, MHS, MS, BSN, RN-CPN
• Julia Friesen, L.C.S.W.
• Alexandra Ann Frogameni, M.D.
• Andrea Fuller
• Watson W Fung, MD
• Leslie Gail
• Susan Galanes, MS
• Janki J Gandhi, PA-C
• Gyu Il Gang, MD

• Multi-Specialty Clinic/Center in Winfield, IL
• Providers in Winfield, IL by specialty
• Multi-Specialty Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2018; 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.