Basic Information
| Provider Information | |||||||||
| NPI: | 1760981138 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REJUVENATE HEALTH INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 534 CHESTNUT ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | HINSDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605213175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304004140 | ||||||||
| FaxNumber: | 6306557425 | ||||||||
| Practice Location | |||||||||
| Address1: | 534 CHESTNUT ST STE 120 | ||||||||
| Address2: | |||||||||
| City: | HINSDALE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605213175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304004140 | ||||||||
| FaxNumber: | 6306557425 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2018 | ||||||||
| LastUpdateDate: | 02/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | BAQIR | ||||||||
| AuthorizedOfficialFirstName: | HASSAN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6304004140 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 038012309 | IL | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.