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General NPI Number Information
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NPI Number | 1932982949
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Entity Type | Organization
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Legal Business Name | RENEW AESTHETICS & WELLNESS CENTER
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 3925 75TH ST STE 101B
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City | AURORA
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State | IL
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Zip | 60504-8001
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Country | US
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Telephone | 630-923-6723
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Fax |
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Provider Business Mailing Address
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Address Line | 881 FINLEY DR
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City | AURORA
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State | IL
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Zip | 60504-8160
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | OLATOKUNBO SHOBANDE
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Credential | MD
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Telephone | 630-926-7299
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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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