Healthcare Provider Details

I. General information

NPI: 1497610521
Provider Name (Legal Business Name): ILUMIWELL PLCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15230 W LA SALLE AVE
LAKEWOOD CO
80228-5520
US

IV. Provider business mailing address

12081 W ALAMEDA PKWY # 444
LAKEWOOD CO
80228-2701
US

V. Phone/Fax

Practice location:
  • Phone: 720-414-3265
  • Fax: 720-414-1724
Mailing address:
  • Phone: 720-414-3265
  • Fax: 720-414-1724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ZORAN LESIC
Title or Position: MEMBER
Credential: MD
Phone: 720-933-0354