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General NPI Number Information
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NPI Number | 1790965176
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Entity Type | Organization
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Legal Business Name | JAMES REVELAS, D.P.M.
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 04/23/2008
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Provider Practice Location Address
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Address Line | 64 EXECUTIVE DR
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City | NORWALK
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State | OH
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Zip | 44857-9568
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Country | US
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Telephone | 419-663-3338
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Fax | 419-668-4731
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Provider Business Mailing Address
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Address Line | 64 EXECUTIVE DRIVE
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City | NORWALK
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State | OH
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Zip | 44857
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Country | US
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Telephone | 419-663-3338
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Fax | 419-668-4731
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES REVELAS
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Credential | D.P.M.
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Telephone | 419-663-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 36-00-2443R
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License Number State | OH
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