MEDICARE: REHABILITATION CONSULTANTS, INC.

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	208100000X	Physical Medicine & Rehabilitation Physician	45600	MN

General Provider Information

NPI Number	:	1710040456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REHABILITATION CONSULTANTS, INC.

Provider Business Mailing Address
First Line	:	3006 FRANK ST
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-5501
Country	:	US
Telephone Number	:	651-699-0633
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 BLUE GENTIAN RD
Second Line	:	SUITE 150
City	:	EAGAN
State	:	MN
Zip	:	55121-1669
Country	:	US
Telephone Number	:	651-379-1600
Fax Number	:	651-379-1650

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. ELENA LEV POLUKHIN
Credential	:	MD
Telephone Number	:	651-699-0633

Provider Enumeration Date	:	12/17/2006
Last Update Date	:	06/18/2009

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