Provider Demographics
NPI:1548966070
Name:RECOMPMD
Entity type:Organization
Organization Name:RECOMPMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHLOE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-224-3478
Mailing Address - Street 1:430 REDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-2748
Mailing Address - Country:US
Mailing Address - Phone:831-224-3478
Mailing Address - Fax:
Practice Address - Street 1:430 REDWOOD LN
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-2748
Practice Address - Country:US
Practice Address - Phone:831-224-3478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225666134OtherNPI