Healthcare Provider Details

I. General information

NPI: 1407766876
Provider Name (Legal Business Name): GOLD BODY MEDSPA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 S BLUE ISLAND AVE STE 204
CHICAGO IL
60608-6148
US

IV. Provider business mailing address

5206 132ND CT
CRESTWOOD IL
60418-4443
US

V. Phone/Fax

Practice location:
  • Phone: 773-340-2315
  • Fax:
Mailing address:
  • Phone: 773-340-2315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: REGINA MUNOZ
Title or Position: OWNER
Credential:
Phone: 773-340-2315