Healthcare Provider Details

I. General information

NPI: 1801603337
Provider Name (Legal Business Name): ENSO WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 ACADEMY DR
NORTHBROOK IL
60062-2420
US

IV. Provider business mailing address

2939 HARTZELL ST
WILMETTE IL
60091-3036
US

V. Phone/Fax

Practice location:
  • Phone: 847-582-0811
  • Fax:
Mailing address:
  • Phone: 847-582-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BENJAMIN
Title or Position: OWNER
Credential:
Phone: 312-965-0614