Provider Demographics
NPI:1699246736
Name:ELEMENT MED SPA, LLC
Entity type:Organization
Organization Name:ELEMENT MED SPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREINT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-987-4555
Mailing Address - Street 1:990 S WAUKEGAN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-2655
Mailing Address - Country:US
Mailing Address - Phone:847-234-0555
Mailing Address - Fax:847-234-0355
Practice Address - Street 1:990 S WAUKEGAN RD STE 200
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-2655
Practice Address - Country:US
Practice Address - Phone:847-234-0555
Practice Address - Fax:847-234-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty