MEDICARE: RENEW AESTHETICS & WELLNESS CENTER

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1932982949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEW AESTHETICS & WELLNESS CENTER

Provider Business Mailing Address
First Line	:	881 FINLEY DR
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-8160
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3925 75TH ST STE 101B
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-8001
Country	:	US
Telephone Number	:	630-923-6723
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	OLATOKUNBO SHOBANDE
Credential	:	MD
Telephone Number	:	630-926-7299

Provider Enumeration Date	:	08/14/2023
Last Update Date	:	08/14/2023

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