REVIVE SKIN INSTITUTE LLC

Dermatology - Procedural Dermatology

Active Organization
NPI: 1104178144

Practice Address

1175 CEDAR CT
CARBONDALE
Carbondale, IL 62901

Phone: (619) 549-0300

Specialties

Specialty Code Primary License
Dermatology 207N00000X No 036094335 (IL)
Dermatology - Procedural Dermatology 207NS0135X Yes 036094335 (IL)

Frequently Asked Questions

NPI 1104178144 is the National Provider Identifier for REVIVE SKIN INSTITUTE LLC, a Dermatology - Procedural Dermatology provider located in Carbondale, IL. This NPI was enumerated on October 14, 2012.

Quick Facts

NPI
1104178144
Type
Organization
Enumerated
Oct 14, 2012
Last Updated
Oct 14, 2012

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