Provider Demographics
NPI:1710027255
Name:REZIN ORTHOPEDICS AND SPORTS MEDICINE, SC
Entity Type:Organization
Organization Name:REZIN ORTHOPEDICS AND SPORTS MEDICINE, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPIELEC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-942-4875
Mailing Address - Street 1:1051 W US ROUTE 6
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-3349
Mailing Address - Country:US
Mailing Address - Phone:815-942-4875
Mailing Address - Fax:915-942-5046
Practice Address - Street 1:1310 HOUBOLT RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-9215
Practice Address - Country:US
Practice Address - Phone:815-741-4000
Practice Address - Fax:815-741-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042007183332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0739010006Medicare NSC