Provider Demographics
NPI:1912596990
Name:REGENERATIVE HEALTH SERVICES
Entity Type:Organization
Organization Name:REGENERATIVE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WULFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-430-2121
Mailing Address - Street 1:1585 SANTA BARBARA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6820
Mailing Address - Country:US
Mailing Address - Phone:352-430-2121
Mailing Address - Fax:352-430-2114
Practice Address - Street 1:1585 SANTA BARBARA BLVD STE A
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-6820
Practice Address - Country:US
Practice Address - Phone:352-430-2121
Practice Address - Fax:352-430-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty