Healthcare Provider Details

I. General information

NPI: 1811819816
Provider Name (Legal Business Name): REAVILL MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PEBBLE BEACH DR
PLAINFIELD IL
60586-8385
US

IV. Provider business mailing address

2200 PEBBLE BEACH DR
PLAINFIELD IL
60586-8385
US

V. Phone/Fax

Practice location:
  • Phone: 815-641-5049
  • Fax:
Mailing address:
  • Phone: 815-641-5049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BEN REAVILL
Title or Position: PRESIDENT
Credential:
Phone: 815-641-5049