MEDICARE: INTEGRATIVE REHABMEDICINE SC

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	2081H0002X	Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician	036-110166	IL

General Provider Information

NPI Number	:	1902014285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATIVE REHABMEDICINE SC

Provider Business Mailing Address
First Line	:	345 EXECUTIVE PKWY STE M4
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-5291
Country	:	US
Telephone Number	:	815-381-8514
Fax Number	:

Provider Business Practice Location Address
First Line	:	345 EXECUTIVE PKWY STE M4
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-5291
Country	:	US
Telephone Number	:	815-381-8514
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICARDO ALFONZO KNIGHT
Credential	:	MD, MBA
Telephone Number	:	630-873-5425

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	04/30/2018

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