Healthcare Provider Details

I. General information

NPI: 1881319911
Provider Name (Legal Business Name): ENVOGUE MED & WELLNESS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E WOODFIELD RD STE 215
SCHAUMBURG IL
60173-5127
US

IV. Provider business mailing address

1701 E WOODFIELD RD STE 215
SCHAUMBURG IL
60173-5127
US

V. Phone/Fax

Practice location:
  • Phone: 847-916-0673
  • Fax: 847-787-9084
Mailing address:
  • Phone: 847-916-0673
  • Fax: 847-787-9084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SANDRA MADRID VALINO STOCK
Title or Position: OWNER/PHYSICIAN
Credential: DO
Phone: 630-670-7279