Provider Demographics
NPI:1366821068
Name:RENEWED MEDICAL HEALTH
Entity Type:Organization
Organization Name:RENEWED MEDICAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:520-298-0005
Mailing Address - Street 1:3382 E SPEEDWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-3936
Mailing Address - Country:US
Mailing Address - Phone:520-298-0005
Mailing Address - Fax:
Practice Address - Street 1:3382 E SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3936
Practice Address - Country:US
Practice Address - Phone:520-298-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty