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NPI Code Detail

MEDICARE: REVIVECARE MEDICAL & WELLNESS LLC

MEDICARE: REVIVECARE MEDICAL & WELLNESS LLC
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
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1659147486
Entity Type Code : Organization
Provider Name (Legal Business Name) : REVIVECARE MEDICAL & WELLNESS LLC
Provider Business Mailing Address
First Line : 1534 BIRCHWOOD AVE
Second Line :
City : KISSIMMEE
State : FL
Zip : 34744-4015
Country : US
Telephone Number : 407-300-8768
Fax Number :
Provider Business Practice Location Address
First Line : 2925 E SOUTH ST
Second Line :
City : ORLANDO
State : FL
Zip : 32803-6459
Country : US
Telephone Number : 321-209-2203
Fax Number : 888-344-9692
Authorized Official
Title or Position : ARNP
Name : TIMA DORON
Credential : ARNP
Telephone Number : 407-300-8768
Provider Enumeration Date : 12/04/2023
Last Update Date : 12/04/2023

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Directions to “REVIVECARE MEDICAL & WELLNESS LLC ” Practice Location

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