Individual
MR. REGINALD ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.E.S. MEDICAL EXERC
Contact information
Practice address
328 PETERSON RD, LIBERTYVILLE, IL 60048-1008
(847) 549-1705
Mailing address
328 PETERSON RD, LIBERTYVILLE, IL 60048-1008
(847) 549-1705
Taxonomy
Speciality
Code
Description
License number
State
224Y00000X
Clinical Exercise Physiologist
Primary
V6RA26-12
IL
Other
Enumeration date
10/03/2012
Last updated
10/03/2012
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