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General NPI Number Information
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NPI Number | 1497574776
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Entity Type | Organization
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Legal Business Name | REPARO HEALTH MEDICAL SERVICES, P.A.
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 401 N MICHIGAN AVE STE 1200
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City | CHICAGO
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State | IL
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Zip | 60611-4264
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Country | US
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Telephone | 260-450-8397
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Fax |
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Provider Business Mailing Address
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Address Line | 401 N MICHIGAN AVE STE 1200
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City | CHICAGO
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State | IL
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Zip | 60611-4264
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Country | US
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Telephone | 260-450-8397
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Fax |
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Authorized Official
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Title or Position | CHIEF ADMINISTRATIVE OFFICER
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Name | NEHA VADALIA
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Credential |
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Telephone | 800-494-6163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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