Provider Demographics
NPI:1033355086
Name:REJUV MEDICAL, P.A.
Entity type:Organization
Organization Name:REJUV MEDICAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAUMGARTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:320-217-8480
Mailing Address - Street 1:901 3RD ST N
Mailing Address - Street 2:
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387-1964
Mailing Address - Country:US
Mailing Address - Phone:321-217-8480
Mailing Address - Fax:320-217-8490
Practice Address - Street 1:901 3RD ST N
Practice Address - Street 2:
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1964
Practice Address - Country:US
Practice Address - Phone:321-217-8480
Practice Address - Fax:320-217-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN43368261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN080012605Medicaid
MN64886800OtherDMERC SUPPLIER NUMBER
MNH38658Medicare UPIN