Organization
GENESIS PEDIATRIC MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ALAN REGNIER M.D. (PRESIDENT)
(815) 899-0001
Entity
Organization
Contact information
Practice address
1830 MEDITERRANEAN DR, SYCAMORE, IL 60178-3144
(815) 899-0001
(815) 899-0002
Mailing address
1830 MEDITERRANEAN DR, SYCAMORE, IL 60178-3144
(815) 899-0001
(815) 899-0002
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036097453
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036097453
—
IL
Enumeration date
07/18/2011
Last updated
07/18/2011
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