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General NPI Number Information
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NPI Number | 1265234967
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Entity Type | Organization
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Legal Business Name | IMMENSE WELLNESS AND MED SPA
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 1312 WAUKEGAN RD
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City | GLENVIEW
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State | IL
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Zip | 60025-3022
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Country | US
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Telephone | 847-595-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 1312 WAUKEGAN RD
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City | GLENVIEW
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State | IL
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Zip | 60025-3022
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER / MEDICAL PROVIDER
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Name | HELEAN ZANDO
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Credential |
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Telephone | 773-414-9411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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