Provider Demographics
NPI:1528671625
Name:BRIGHTLIFE REGENERATIVE MEDICAL CLINIC SCHAUMBURG SC
Entity type:Organization
Organization Name:BRIGHTLIFE REGENERATIVE MEDICAL CLINIC SCHAUMBURG SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-278-6062
Mailing Address - Street 1:44 W SCHAUMBURG RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3502
Mailing Address - Country:US
Mailing Address - Phone:847-278-6062
Mailing Address - Fax:847-490-9009
Practice Address - Street 1:44 W SCHAUMBURG RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3502
Practice Address - Country:US
Practice Address - Phone:847-278-6062
Practice Address - Fax:847-490-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty