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General NPI Number Information
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NPI Number | 1720718331
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Entity Type | Organization
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Legal Business Name | RENEW AESTHETICS LLC
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 1008 E UNIVERSITY DR
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City | GRANGER
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State | IN
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Zip | 46530
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Country | US
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Telephone | 574-318-4148
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Fax |
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Provider Business Mailing Address
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Address Line | 6220 N 300 E
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City | LEESBURG
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State | IN
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Zip | 46538-9124
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Country | US
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Telephone | 574-206-6816
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHILIP BEMILLER
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Credential | MD
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Telephone | 574-206-6816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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