Healthcare Provider Details

I. General information

NPI: 1649066895
Provider Name (Legal Business Name): MPOWER WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3423 CHURCH ST
EVANSTON IL
60203-1714
US

IV. Provider business mailing address

3223 LAKE AVE STE 15C
WILMETTE IL
60091-1069
US

V. Phone/Fax

Practice location:
  • Phone: 773-500-3650
  • Fax: 773-284-6290
Mailing address:
  • Phone: 847-951-5139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080B0002X
TaxonomyPediatric Obesity Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNIFER ANN PEREZ
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 847-951-5139