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General NPI Number Information
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NPI Number | 1942879572
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Entity Type | Organization
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Legal Business Name | REVITALIZE IV SOLUTIONS, LLC
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Dates
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Enumeration Date | 06/18/2021
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Last Update Date | 08/05/2021
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Provider Practice Location Address
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Address Line | 7237 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60634-3546
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Country | US
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Telephone | 773-417-4556
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Fax | 855-958-5430
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Provider Business Mailing Address
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Address Line | 7237 W IRVING PARK RD
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City | CHICAGO
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State | IL
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Zip | 60634-3546
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Country | US
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Telephone | 773-417-4556
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Fax | 855-958-5430
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAWN BELVIS
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Credential | MD
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Telephone | 773-417-4556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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