Healthcare Provider Details

I. General information

NPI: 1245379833
Provider Name (Legal Business Name): REZIN ORTHOPEDIC & SPORTS MEDICINE, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E COUNTRYSIDE PKWY
YORKVILLE IL
60560-1815
US

IV. Provider business mailing address

1051 W US ROUTE 6 SUITE 100
MORRIS IL
60450-3349
US

V. Phone/Fax

Practice location:
  • Phone: 630-553-8979
  • Fax: 630-553-3983
Mailing address:
  • Phone: 815-942-4875
  • Fax: 815-942-5046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. ERIC ANDERSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 815-942-4875