Provider Demographics
NPI:1235467903
Name:HEALTH AND RENEWAL INTERNAL MEDICINE SC
Entity Type:Organization
Organization Name:HEALTH AND RENEWAL INTERNAL MEDICINE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:DIXON-GREVIOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-850-3855
Mailing Address - Street 1:849 W OHIO ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-6982
Mailing Address - Country:US
Mailing Address - Phone:312-850-3855
Mailing Address - Fax:312-850-3856
Practice Address - Street 1:2850 W 95TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2735
Practice Address - Country:US
Practice Address - Phone:708-389-2200
Practice Address - Fax:708-389-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100552261QM2500X
IN01060010A261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty