Provider Demographics
NPI:1689405078
Name:INTEGRITY MEDICAL AND WOUNDS GROUP IL RLLP
Entity type:Organization
Organization Name:INTEGRITY MEDICAL AND WOUNDS GROUP IL RLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:GARALDE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-580-7997
Mailing Address - Street 1:8770 W BRYN MAWR AVE STE 1300
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3557
Mailing Address - Country:US
Mailing Address - Phone:702-580-7997
Mailing Address - Fax:
Practice Address - Street 1:8600 W BRYN MAWR AVE # 8700
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3579
Practice Address - Country:US
Practice Address - Phone:702-580-7997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty