Supreme Wellness Aesthetics & Recovery Inc

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

SUPREME WELLNESS AESTHETICS & RECOVERY INC

Practice address

678 N Northwest Hwy Ste C
Park Ridge, IL 60068-2540

Phone

(847) 653-6191

NPI assigned

Jul 13, 2021

Last updated

Aug 5, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dominika Pavone, RN

Title

Owner

Phone

(630) 635-6633

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628121600000",
    "number": "1275105967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "678 N NORTHWEST HWY STE C",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600682540",
            "telephone_number": "847-653-6191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "678 N NORTHWEST HWY STE C",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600682540",
            "telephone_number": "847-653-6191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME WELLNESS AESTHETICS & RECOVERY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-13",
        "last_updated": "2021-08-05",
        "certification_date": "2021-08-05",
        "status": "A",
        "authorized_official_last_name": "PAVONE",
        "authorized_official_first_name": "DOMINIKA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-635-6633",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hibba Sumra, MD
• Amy F Sun, M.D.
• Michelle Lynn Sun, DO
• Sunova Healthcare S.C.
• Sunrise Senior Living Management, Inc, (Sunrise of Park Ridge)
• Sajid Sattar Suriya, MD
• Stephanie C Surkin, DPT
• Susan K Burrowes MD LLC
• Susana Salcedo MD LLC
• Joshua Thomas Sutherland

• Emergency Medicine Physician in Park Ridge, IL
• Providers in Park Ridge, IL by specialty
• Emergency Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.