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General NPI Number Information
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NPI Number | 1760628820
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Entity Type | Individual
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Provider Name | ELIZABETH KNACKMUHS REVERE MD
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Gender | Female
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Dates
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Enumeration Date | 12/19/2008
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 5339 N IH 35
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City | AUSTIN
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State | TX
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Zip | 78723-2557
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Country | US
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Telephone | 512-978-8130
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 E CESAR CHAVEZ ST
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City | AUSTIN
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State | TX
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Zip | 78702-4209
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 250049
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 250049
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | R9673
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License Number State | TX
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