MEDICARE: ORNA A REGEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	224627	NY

General Provider Information

NPI Number	:	1134327604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ORNA A REGEN MD

Provider Business Mailing Address
First Line	:	4848 W. IRVING PARK ROAD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4848 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2718
Country	:	US
Telephone Number	:	855-625-7878
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2007
Last Update Date	:	03/07/2023

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