Revis, Paul
Revis, Paul is an individual health care provider with primary practice located at 1055 Featherstone Rd , Rockford IL 61107-5904. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Revis, Paul can be contacted via phone (815) 227-1055.Contact Information
Primary practice address
1055 Featherstone Rd
Rockford IL 61107-5904
Phone: (815) 227-1055
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | 036067857 | Illinois |
Profile Details
| NPI number | 1518984293 |
|---|---|
| LBN Legal business name | Revis, Paul |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 17th, 2006 |
| Last updated | Jan 16th, 2017 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1518984293 | NPPES |
| Illinois | MEDICAID | 036067857 |
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