Healthcare Provider Details

I. General information

NPI: 1093818494
Provider Name (Legal Business Name): REHABILITATION MEDICINE CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26W171 ROOSEVELT RD
WHEATON IL
60187-6078
US

IV. Provider business mailing address

DEPT 5777
CAROL STREAM IL
60122-5777
US

V. Phone/Fax

Practice location:
  • Phone: 630-909-7350
  • Fax: 630-909-7351
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL MULLEN
Title or Position: DIRECTOR
Credential:
Phone: 630-909-7354