Provider Demographics
NPI:1669098406
Name:MEDICAL AESTHETICS & REGENERATIVE CENTER
Entity type:Organization
Organization Name:MEDICAL AESTHETICS & REGENERATIVE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REY
Authorized Official - Middle Name:NANGKIL
Authorized Official - Last Name:BELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-248-3138
Mailing Address - Street 1:6311 KINGSTON PIKE STE 3E
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4906
Mailing Address - Country:US
Mailing Address - Phone:865-248-3138
Mailing Address - Fax:865-381-9767
Practice Address - Street 1:6311 KINGSTON PIKE STE 3E
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4906
Practice Address - Country:US
Practice Address - Phone:865-248-3138
Practice Address - Fax:865-381-9767
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL AESTHETICS & REGENERATIVE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty