Healthcare Provider Details

I. General information

NPI: 1902311921
Provider Name (Legal Business Name): REZIN ORTHOPEDIC & SPORTS MEDICINE, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 W US ROUTE 6 STE 400
MORRIS IL
60450-3370
US

IV. Provider business mailing address

1051 W US ROUTE 6 STE 100
MORRIS IL
60450-3370
US

V. Phone/Fax

Practice location:
  • Phone: 815-942-8301
  • Fax: 815-942-8449
Mailing address:
  • Phone: 815-942-4875
  • Fax: 815-942-5046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number042007183
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number042007183
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number042007183
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number042007183
License Number StateIL

VIII. Authorized Official

Name: MICHAEL TOPIELEC
Title or Position: ADMINISTRATOR
Credential:
Phone: 815-942-4875