Basic Information
| Provider Information | |||||||||
| NPI: | 1093860421 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REHABILITATION MEDICINE ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 OAKMONT LN | ||||||||
| Address2: | SUITE 1600 | ||||||||
| City: | WESTMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605595511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307892550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8840 CALUMET AVE | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463212529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198366422 | ||||||||
| FaxNumber: | 2198367245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 03/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | NEELAVENI | ||||||||
| AuthorizedOfficialFirstName: | PADMAJA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2198366422 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 000000327090 | 01 | IN | ANTHEM | OTHER | DB9159 | 01 | RAILROAD MEDICARE | OTHER | 000000327090 | 01 | IN | BCBS | OTHER | 000000327090 | 01 | IN | IN COMPREHENSIVE INSURANC | OTHER |