Provider Demographics
NPI:1174164057
Name:REGENERATIVE MEDICAL INSTITUTE,PLLC
Entity type:Organization
Organization Name:REGENERATIVE MEDICAL INSTITUTE,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KWADWO
Authorized Official - Middle Name:GYARTENG
Authorized Official - Last Name:DAKWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-894-1188
Mailing Address - Street 1:1305 W. WENDOVER AVE.
Mailing Address - Street 2:STE A
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408
Mailing Address - Country:US
Mailing Address - Phone:336-894-1188
Mailing Address - Fax:336-458-2593
Practice Address - Street 1:1305 W. WENDOVER AVE.
Practice Address - Street 2:STE A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408
Practice Address - Country:US
Practice Address - Phone:336-894-1188
Practice Address - Fax:336-458-2593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty