Revive Skin Institute Llc

NPI 1104178144 - Dermatology - 207N00000X

NPI Details
NPI 1104178144
Enumeration Date 10/14/2012
Last Updated 10/14/2012
Entity Type Healthcare Provider
Active Over 4 years ago
Authorized Information
Name ANUP KUMAR ANUP
Position MEMBER
Phone (619) 549-0300
Fax
Practice Location
1175 CEDAR CT
CARBONDALE
CARBONDALE IL, 62901-5333, US
Phone (619) 549-0300
Fax
Business Location
1175 CEDAR CT
CARBONDALE
CARBONDALE IL, 62901-5333, US
Phone (619) 549-0300
Fax
Toxanomy
Taxonomy Code 207N00000X
License State Illinois
License Number 036094335
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According to our database, Revive Skin Institute Llc NPI is 1104178144, taxonomy code is 207N00000X and license number is 036094335, license state is located at Illinois. Revive Skin Institute Llc physically located at 1175 Cedar Ct, Carbondale IL, 62901-5333. NPI Number 1033115704 has the healthcare provider type.

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1104178144 NPI number is provided on an as is basis without warranty of any kind. 1104178144 is maintained by the National Plan & Provider Enumeration System. The contents of Revive Skin Institute Llc are for informational purposes only.