| Lotus Wellness Center P.c. | |
|
1292 W Northwest Hwy Palatine IL 60067 | |
| (773) 592-7227 | |
| Not Available |
| Full Name | Lotus Wellness Center P.c. |
|---|---|
| Speciality | Counselor |
| Location | 1292 W Northwest Hwy, Palatine, Illinois |
| Authorized Official Name and Position | Leo Gerdov (OWNER) |
| Authorized Official Contact | 6309885364 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lotus Wellness Center P.c. 638 Dunsten Cir Northbrook IL 60062-2613 Ph: () - | Lotus Wellness Center P.c. 1292 W Northwest Hwy Palatine IL 60067 Ph: (773) 592-7227 |
| NPI Number | 1114450061 |
|---|---|
| Provider Enumeration Date | 04/07/2017 |
| Last Update Date | 06/21/2018 |
| Medicare PECOS PAC ID | 8921375908 |
|---|---|
| Medicare Enrollment ID | O20170523000465 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114450061 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 180009919 (Illinois) | Primary |
| 111N00000X | Chiropractor | 038011689 (Illinois) | Secondary |
| Provider Name | Leo Gerdov |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1366760308 PECOS PAC ID: 7810181245 Enrollment ID: I20101029001181 |
| Provider Name | Liana Gerdov |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1649539560 PECOS PAC ID: 1850700030 Enrollment ID: I20210430000123 |
| Provider Name | Emily E Dohm |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679106207 PECOS PAC ID: 7719385392 Enrollment ID: I20211012002727 |
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