Healthcare Provider Details

I. General information

NPI: 1699783787
Provider Name (Legal Business Name): REZIN ORTHOPEDICS AND SPORTS MEDICINE, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 815-942-4875
  • Fax: 815-942-8349
Mailing address:
  • Phone: 815-942-4875
  • Fax: 815-942-8349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number042007183
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number042007183
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number042007183
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number042007183
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number042007183
License Number StateIL
# 7
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number042007183
License Number StateIL

VIII. Authorized Official

Name: MR. MICHAEL TOPIELEC
Title or Position: ADMINISTRATOR
Credential:
Phone: 815-318-5645