Provider Demographics
NPI:1730702812
Name:REGENERATE WELLNESS INC
Entity type:Organization
Organization Name:REGENERATE WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-514-7306
Mailing Address - Street 1:2631 E OAKLAND PARK BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33306-1607
Mailing Address - Country:US
Mailing Address - Phone:954-514-7306
Mailing Address - Fax:954-337-6408
Practice Address - Street 1:2631 E OAKLAND PARK BLVD STE 110
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1607
Practice Address - Country:US
Practice Address - Phone:954-514-7306
Practice Address - Fax:954-337-6408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-22
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty