Healthcare Provider Details

I. General information

NPI: 1871546473
Provider Name (Legal Business Name): REHABILITATION ASSOCIATES OF THE MIDWEST, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 E PALATINE RD
PALATINE IL
60074-5551
US

IV. Provider business mailing address

909 E PALATINE RD
PALATINE IL
60074-5551
US

V. Phone/Fax

Practice location:
  • Phone: 847-776-1400
  • Fax: 847-776-1424
Mailing address:
  • Phone: 847-776-1400
  • Fax: 847-776-1424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. GREGORY W SWANSON
Title or Position: CFO, BUSINESS MANAGER
Credential: CPA
Phone: 847-776-1400