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General NPI Number Information
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NPI Number | 1013227214
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Entity Type | Organization
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Legal Business Name | SEAN MICHAEL RARDIN S.C.
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 02/11/2011
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Provider Practice Location Address
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Address Line | 1300 N HIGHLAND AVE
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City | AURORA
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State | IL
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Zip | 60506-1451
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Country | US
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Telephone | 630-892-7629
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 N HIGHLAND AVE
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City | AURORA
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State | IL
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Zip | 60506-1451
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Country | US
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Telephone | 630-892-7629
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Fax |
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Authorized Official
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Title or Position | OFFICE ASSISTANT
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Name | CARRIE RARDIN
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Credential |
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Telephone | 630-219-3172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036114032
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License Number State | IL
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