Life Rejuvenated USA, LLC

Primary specialty

Point of ServiceTaxonomy code 305S00000X

Legal business name

LIFE REJUVENATED USA, LLC

Doing business as

Life Rejuvenated

Practice address

1935 County Road B2 W Ste 74
Roseville, MN 55113-2722

Phone

(800) 583-5290

NPI assigned

Jun 4, 2021

Last updated

Jun 4, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Simon Mittal, MD

Title

President

Phone

(507) 363-9367

Specialties & licenses 2

Addresses

Other names 1

• Life Rejuvenated Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Vikas Simon Mittal, MD

  • Internal Medicine Physician
  • Saint Paul, MN
  • NPI 1629038377
  NPD

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

{
    "created_epoch": "1622764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622764800000",
    "number": "1780251223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1675 VILLAGE TRL E UNIT 6",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551095820",
            "telephone_number": "507-363-9367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1935 COUNTY ROAD B2 W STE 74",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551132722",
            "telephone_number": "800-583-5290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE REJUVENATED USA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-04",
        "last_updated": "2021-06-04",
        "certification_date": "2021-06-04",
        "status": "A",
        "authorized_official_last_name": "MITTAL",
        "authorized_official_first_name": "SIMON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "507-363-9367",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Rejuvenated",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kristin A Lieberman, MD
• Jill Liebers
• Life Curation, PLLC
• Life Insurance Agency, Inc. (Home Healthcare Agency)
• Lifeline Care LLC
• Lifequest Therapeutic Services
• Michael F Lin, MD
• Angela Lindberg
• Steven Link, M.D.

• Point of Service in Roseville, MN
• Providers in Roseville, MN by specialty
• Point of Service in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2021; 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.