Provider Demographics
NPI:1770215816
Name:FAIRWOOD REGENERATIVE MEDICINE
Entity Type:Organization
Organization Name:FAIRWOOD REGENERATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HYTHEM
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-843-1515
Mailing Address - Street 1:5215 MONROE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-3190
Mailing Address - Country:US
Mailing Address - Phone:419-843-1515
Mailing Address - Fax:419-715-9554
Practice Address - Street 1:5215 MONROE ST STE 5
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3190
Practice Address - Country:US
Practice Address - Phone:419-843-1515
Practice Address - Fax:419-715-9554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty