Dermatology

LBN: Revive Skin Institute Llc
Dermatology is an health care organization with primary practice located at 1175 Cedar Ct Carbondale, Carbondale IL 62901-5333. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / Procedural Dermatology. Allopathic & Osteopathic Physicians / Procedural Dermatology is the primary health care specialty. Revive Skin Institute Llc can be contacted via phone (619) 549-0300, or through Chaudhry, Anup Kumar via phone (618) 549-0300.

Contact Information

Primary practice address
1175 Cedar Ct Carbondale Carbondale IL 62901-5333
Phone: (619) 549-0300
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Chaudhry, Anup Kumar Doctor of Medicine (MD)
Phone: (618) 549-0300

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 036094335 Illinois
Allopathic & Osteopathic Physicians / Procedural Dermatology 207NS0135X 036094335 Illinois

Profile Details

NPI number 1104178144
LBN Legal business name Revive Skin Institute Llc
DBA Doing business as Dermatology
Authorized official Chaudhry, Anup Kumar Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Oct 14th, 2012
Last updated Oct 14th, 2012 - about 14 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104178144 NPPES
Illinois MEDICAID 036094335

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