Provider Demographics
NPI:1013227214
Name:SEAN MICHAEL RARDIN S.C.
Entity Type:Organization
Organization Name:SEAN MICHAEL RARDIN S.C.
Other - Org Name:RIVERWALK FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-219-3172
Mailing Address - Street 1:1300 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1451
Mailing Address - Country:US
Mailing Address - Phone:630-892-7629
Mailing Address - Fax:
Practice Address - Street 1:1300 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1451
Practice Address - Country:US
Practice Address - Phone:630-892-7629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114032261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care