Brightlife Regenerative Medical Clinic Lombard Sc
General Practice in Lombard, IL. Organization (NPI-2).
NPI number1306465786
StatusActive
Last updated in NPPESApr 17, 2020
Details
- NPI
- 1306465786
- Entity type
- Organization (NPI-2)
- Legal business name
- Brightlife Regenerative Medical Clinic Lombard Sc
- Organization subpart
- No
- Enumeration date
- Apr 15, 2020
- Certification date
- Apr 17, 2020
- Last updated
- Apr 17, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208D00000X | General Practice | – | – | Yes |
Practice location
442 E Roosevelt RdLombard, IL 60148-4630
Phone 630-261-0001
Mailing address
442 E Roosevelt RdLombard, IL 60148-4630
Phone 630-261-0001
Authorized official
Steven Burlison
President
6302610001
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