Provider Demographics
NPI:1720718331
Name:RENEW AESTHETICS LLC
Entity Type:Organization
Organization Name:RENEW AESTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:BEMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-206-6816
Mailing Address - Street 1:6220 N 300 E
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46538-9124
Mailing Address - Country:US
Mailing Address - Phone:574-206-6816
Mailing Address - Fax:
Practice Address - Street 1:1008 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530
Practice Address - Country:US
Practice Address - Phone:574-318-4148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center