Healthcare Provider Details

I. General information

NPI: 1386783199
Provider Name (Legal Business Name): REZIN ORTHOPEDIC & SPORTS MEDICINE, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 01/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16101 WEBER RD ADVANCED PHYSICIANS BUILDING
CREST HILL IL
60435-8812
US

IV. Provider business mailing address

1051 W US ROUTE 6 SUITE 100
MORRIS IL
60450-3349
US

V. Phone/Fax

Practice location:
  • Phone: 815-836-2668
  • Fax: 815-836-8799
Mailing address:
  • Phone: 815-942-4875
  • Fax: 815-942-5046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC ANDERSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 815-942-4875