Healthcare Provider Details

I. General information

NPI: 1043359961
Provider Name (Legal Business Name): REZIN ORTHOPEDIC AND 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

1122 HOUBOLT RD
JOLIET IL
60431-9063
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 815-741-4000
  • Fax: 815-741-4222
Mailing address:
  • Phone: 815-942-4875
  • Fax: 815-942-5046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 7
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