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General NPI Number Information
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NPI Number | 1598601163
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Entity Type | Organization
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Legal Business Name | REVO PHYSICIAN GROUP LLC
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 7101 N CICERO AVE STE 200
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-2112
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Country | US
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Telephone | 212-734-6621
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Fax |
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Provider Business Mailing Address
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Address Line | 7101 N CICERO AVE STE 200
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-2112
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Country | US
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Telephone | 212-734-6621
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NATHANIEL MONTAG
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Credential |
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Telephone | 212-734-6621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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