Provider Demographics
NPI:1417148685
Name:REJUVENETICS, LTD
Entity Type:Organization
Organization Name:REJUVENETICS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-383-4444
Mailing Address - Street 1:137 N OAK PARK AVE
Mailing Address - Street 2:STE 208
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1344
Mailing Address - Country:US
Mailing Address - Phone:708-383-4444
Mailing Address - Fax:
Practice Address - Street 1:137 N OAK PARK AVE
Practice Address - Street 2:STE 208
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1344
Practice Address - Country:US
Practice Address - Phone:708-383-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03655851261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty