MEDICARE: REGENERATE WELLNESS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1730702812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGENERATE WELLNESS INC

Provider Business Mailing Address
First Line	:	2631 E OAKLAND PARK BLVD STE 110
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1607
Country	:	US
Telephone Number	:	954-514-7306
Fax Number	:	954-337-6408

Provider Business Practice Location Address
First Line	:	2631 E OAKLAND PARK BLVD STE 110
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1607
Country	:	US
Telephone Number	:	954-514-7306
Fax Number	:	954-337-6408

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL I COHEN
Credential	:	DC
Telephone Number	:	954-514-7306

Provider Enumeration Date	:	05/22/2020
Last Update Date	:	05/26/2020

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