Rejuvenesse

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036100063 Issued in IL

Legal business name

REJUVENESSE

Practice address

5911 Northwest Hwy
Suite 101
Crystal Lake, IL 60014-8065

Phone

(815) 788-1992

Fax

(815) 788-1993

NPI assigned

Jul 19, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Syed Waseem Haider, M.D.

Title

M.D.

Phone

(815) 788-1992

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1279497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279497600000",
    "number": "1275846362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5911 NORTHWEST HWY",
            "address_2": "SUITE 108",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600148065",
            "telephone_number": "815-788-1992",
            "fax_number": "815-788-1993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5911 NORTHWEST HWY",
            "address_2": "SUITE 101",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600148065",
            "telephone_number": "815-788-1992",
            "fax_number": "815-788-1993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REJUVENESSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-19",
        "last_updated": "2010-07-19",
        "status": "A",
        "authorized_official_last_name": "HAIDER",
        "authorized_official_first_name": "SYED",
        "authorized_official_middle_name": "WASEEM",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "815-788-1992",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036100063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.