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General NPI Number Information
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NPI Number | 1144936170
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Entity Type | Organization
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Legal Business Name | MINDFUL MEDISPA AND MEDICLINIC PLLC
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 1626 W ALGONQUIN RD
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60192-1587
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Country | US
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Telephone | 224-634-1500
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Fax | 224-253-4669
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Provider Business Mailing Address
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Address Line | 1626 W ALGONQUIN RD
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60192-1587
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Country | US
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Telephone | 224-634-1500
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Fax | 224-253-4669
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | LUCIE BIANCHI
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Credential | MD
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Telephone | 224-634-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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