Healthcare Provider Details

I. General information

NPI: 1962929018
Provider Name (Legal Business Name): AFFINITY INTEGRATED HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 FLORSHEIM DR, ST 12
LIBERTYVILLE IL
60048
US

IV. Provider business mailing address

736 FLORSHEIM DR, ST 12
LIBERTYVILLE IL
60048
US

V. Phone/Fax

Practice location:
  • Phone: 847-680-3900
  • Fax: 847-680-2026
Mailing address:
  • Phone: 847-680-3900
  • Fax: 847-680-2026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. RONALD M REBMANN
Title or Position: PRESIDENT/OWNER
Credential: DC
Phone: 847-680-3900