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General NPI Number Information
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NPI Number | 1841697265
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Entity Type | Organization
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Legal Business Name | RESTOR MEDICAL INC
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Dates
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Enumeration Date | 12/01/2014
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Last Update Date | 12/01/2014
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Provider Practice Location Address
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Address Line | 416 E ROOSEVELT RD STE 107
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City | WHEATON
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State | IL
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Zip | 60187-5589
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Country | US
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Telephone | 630-682-5090
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Fax | 630-260-1230
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Provider Business Mailing Address
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Address Line | 416 E ROOSEVELT RD STE 107
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City | WHEATON
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State | IL
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Zip | 60187-5589
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Country | US
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Telephone | 630-682-5090
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Fax | 630-260-1230
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Authorized Official
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Title or Position | CEO
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Name | DR. KRISTINA SARGENT
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Credential | D.C.
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Telephone | 630-682-5090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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