Provider Demographics
NPI:1336735562
Name:STRIVEMD WELLNESS & KETAMINE PLLC
Entity Type:Organization
Organization Name:STRIVEMD WELLNESS & KETAMINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD / PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-509-3726
Mailing Address - Street 1:8707 SKOKIE BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2281
Mailing Address - Country:US
Mailing Address - Phone:847-213-0990
Mailing Address - Fax:
Practice Address - Street 1:8707 SKOKIE BLVD STE 307
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2281
Practice Address - Country:US
Practice Address - Phone:847-213-0990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty