1710027255 NPI number — REZIN ORTHOPEDICS AND SPORTS MEDICINE, SC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710027255 NPI number — REZIN ORTHOPEDICS AND SPORTS MEDICINE, SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REZIN ORTHOPEDICS AND SPORTS MEDICINE, SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710027255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1051 W US ROUTE 6
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
MORRIS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60450-3349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-942-4875
Provider Business Mailing Address Fax Number:
915-942-5046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 HOUBOLT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOLIET
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60431-9215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-741-4000
Provider Business Practice Location Address Fax Number:
815-741-4222
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TOPIELEC
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
815-942-4875

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  042007183 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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