Healthcare Provider Details

I. General information

NPI: 1811866452
Provider Name (Legal Business Name): IMMUNOCARE CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 N MICHIGAN AVE STE 438825
CHICAGO IL
60611-4501
US

IV. Provider business mailing address

7600 VIOLET LN
JOLIET IL
60431-7891
US

V. Phone/Fax

Practice location:
  • Phone: 815-457-7889
  • Fax: 815-846-8674
Mailing address:
  • Phone: 815-457-7889
  • Fax: 844-749-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MARTEL SHANTAZE WARDEN
Title or Position: OWNER
Credential: APRN-FPA, FNP-C
Phone: 815-457-7889