NPI 1104857341 · live from the CMS NPI Registry
Abraham'S Mark Comprehensive Wellness Center, Sc
Clinic/Center, Primary Care in Chicago, IL. National Provider Identifier 1104857341, active.
NPI record
| NPI | 1104857341 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Clinic/Center, Primary Care 261QP2300X |
| Practice location | 9500 S Dorchester Ave, Ste 100, Chicago, IL 60628 |
| Practice phone | 773-667-0768 |
| Mailing address | Po Box 13677, Belfast, ME 04915 |
| Enumerated | July 5, 2006 |
| Last updated | March 29, 2026 |
| Authorized official | Nicole King, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Medicine | 207Q00000X | — |
| Clinic/Center, Primary Care primary | 261QP2300X | 036096686 (IL) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.