Provider Demographics
NPI:1093818494
Name:REHABILITATION MEDICINE CLINIC, INC.
Entity Type:Organization
Organization Name:REHABILITATION MEDICINE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-909-7354
Mailing Address - Street 1:DEPT 5777
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-5777
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26W171 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-6078
Practice Address - Country:US
Practice Address - Phone:630-909-7350
Practice Address - Fax:630-909-7351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002230296OtherBLUE CROSS BLUE SHIELD
IL0002230296OtherBLUE CROSS BLUE SHIELD
IL526740Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
IL528850Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
IL527520Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
528860Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
IL214608Medicare ID - Type UnspecifiedMEDICARE GROUP #