Provider Demographics
NPI:1407867393
Name:REZIN, KEITH MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:MICHAEL
Last Name:REZIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 SCHOOL ST STE A
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1207
Mailing Address - Country:US
Mailing Address - Phone:815-941-9124
Mailing Address - Fax:815-941-4363
Practice Address - Street 1:1051 W US ROUTE 6
Practice Address - Street 2:SUITE 100
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-3349
Practice Address - Country:US
Practice Address - Phone:815-942-4875
Practice Address - Fax:915-942-5046
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036076751207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076751Medicaid
IL3200053OtherBCBS
IL0739010005OtherMEDICARE NSC
ILCL7476OtherRAILROAD MEDICARE GROUP #
IL020437OtherHEALTH ALLIANCE
IL0739010006OtherMEDICARE NSC
IL200011528OtherRR MEDICARE
IL0739010008OtherMEDICARE NSC
IL0739010001OtherMEDICARE NSC
IL3200053OtherBCBS
IL036076751Medicaid
IL200011528OtherRR MEDICARE
IL0739010006OtherMEDICARE NSC
IL370830Medicare ID - Type UnspecifiedLOCALITY 99