MEDICARE: VLADYSLAV REVIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	R74619	AZ

General Provider Information

NPI Number	:	1154737674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VLADYSLAV REVIN MD

Provider Business Mailing Address
First Line	:	1501 N CAMPBELL AVENUE, 6TH FLOOR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85724-5023
Country	:	US
Telephone Number	:	520-874-4217
Fax Number	:	520-874-4226

Provider Business Practice Location Address
First Line	:	1501 N CAMPBELL AVENUE, 6TH FLOOR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85724-5023
Country	:	US
Telephone Number	:	520-694-8888
Fax Number	:	520-694-0235

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2014
Last Update Date	:	06/26/2019

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