Provider Demographics
NPI:1265234967
Name:IMMENSE WELLNESS AND MED SPA
Entity type:Organization
Organization Name:IMMENSE WELLNESS AND MED SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MEDICAL PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:HELEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-414-9411
Mailing Address - Street 1:1312 WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3022
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1312 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-3022
Practice Address - Country:US
Practice Address - Phone:847-595-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-25
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine