Healthcare Provider Details

I. General information

NPI: 1518743152
Provider Name (Legal Business Name): EVOKE WELLNESS AT CHICAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E OAKTON ST STE 14
DES PLAINES IL
60018-2171
US

IV. Provider business mailing address

3600 RED RD STE 606B
MIRAMAR FL
33025-6016
US

V. Phone/Fax

Practice location:
  • Phone: 954-993-2040
  • Fax: 954-990-6305
Mailing address:
  • Phone: 954-993-2040
  • Fax: 954-990-6305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHERITA CHANG
Title or Position: CRO
Credential: MS
Phone: 954-993-2040