Healthcare Provider Details

I. General information

NPI: 1871287144
Provider Name (Legal Business Name): HARMONY WEIGHT LOSS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10203 COLLINS AVE UNIT 1205
BAL HARBOUR FL
33154-1857
US

IV. Provider business mailing address

10203 COLLINS AVE UNIT 1205
BAL HARBOUR FL
33154-1857
US

V. Phone/Fax

Practice location:
  • Phone: 312-618-0000
  • Fax:
Mailing address:
  • Phone: 312-618-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JORDAN DESNICK
Title or Position: MANAGER
Credential:
Phone: 312-618-0000