Organization
INNOVATIVE MEDSPA PLLC
Active
Organization
INNOVATIVE MEDSPA PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD BOHMER (COO)
(773) 562-0110
Entity
Organization
Contact information
Practice address
2418 N ASHLAND AVE, CHICAGO, IL 60614-2021
(773) 900-8330
Mailing address
2418 N ASHLAND AVE, CHICAGO, IL 60614-2021
(773) 900-8330
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
05/28/2024
Last updated
05/28/2024
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