REVITALIZE MEDICAL CENTER LLC (NPI# 1467934414) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467934414 |
| Entity Type | Organization |
| Organization Name | REVITALIZE MEDICAL CENTER LLC |
| Practice Address |
800 Austin St Ste 466 Evanston IL 60202-3455 |
| Mailing Address |
1787 Orchard Lane #8117 Northfield IL 60093 |
| Practice Telephone | 8473284451 |
| Mailing Telephone | 8478344018 |
| Mailing Fax Number | 8478344944 |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2019-09-28 |
| Authorized Official Name | DR. SHEETAL K DECARIA (OWNER) |
| Authorized Official Telephone | 8478344018 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
800 AUSTIN ST STE 466 |
| City | EVANSTON |
| State | IL |
| Zip Code | 60202-3455 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649569534 | Sheetal K Decaria | Anesthesiology | 800 Austin St Ste 466, Evanston, IL 60202-3455 | 2011-03-31 |
| 1801297288 | North Suburban Ultrasound, LLC | Clinic/Center | 800 Austin St Ste 466, Evanston, IL 60202-3455 | 2014-09-04 |
| 1558762997 | Bradley Lazar | Radiologic Technologist | 800 Austin St Ste 466, Evanston, IL 60202-3455 | 2014-09-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548889496 | Ktsmiles, Inc | Clinic/Center | 2408 Main Street, Evanston, IL 60202 | 2020-04-10 |
| 1831751163 | Dorcas Matowe | Marriage & Family Therapist | The Family Institute, 618 Library Place, Evanston, IL 60202 | 2019-07-08 |
| 1457847170 | Lilah Handler | Social Worker | 905 Forest Ave, Apt 1, Evanston, IL 60202 | 2018-07-05 |
| 1528574472 | Jessica Kubacki | Developmental Therapist | 535 Hinman Ave Apt F3, Evanston, IL 60202 | 2017-12-14 |
| 1376075853 | Lisa Meyerson Acupuncture | Acupuncturist | 1234 Sherman Avenue, Lighthouse Yoga and Acupuncture, Evanston, IL 60202 | 2017-04-03 |
| 1427597368 | Lillian Obucina Dds PC | Dentist | 111 North Wabash, Suite 1522, Chicago, IL 60202 | 2017-02-13 |
| 1184176893 | Amelia Willcox | Speech-Language Pathologist | 620 Sheridan Square, Apartment 1, Evanston, IL 60202 | 2016-10-28 |
| 1831547785 | Thomas Hagerty Jr. | Pharmacist | 2491 W Howard St, Evanston, IL 60202 | 2016-06-01 |
| 1013361948 | Autism Hope Support | In Home Supportive Care | 815 Seward Apt. 1s, Evanston, IL 60202 | 2016-04-18 |
| 1215302625 | Preferred Dentistry Associates, LLC | Dentist | 1029 Howard Street, Evanston, IL 60202 | 2015-12-10 |
| Find all providers in zip 60202 | ||||
| Taxonomy Code | 208VP0014X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Interventional Pain Medicine |
| Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295365005 | Interventional Pain Consultants LLC | Pain Medicine | 4972 Benchmark Centre Dr Ste 400, Swansea, IL 62226-2070 | 2020-01-21 |
| 1922588110 | Pain Specialists of Greater Chicago S C | Pain Medicine | 15300 West Ave Ste C213, Orland Park, IL 60462 | 2018-08-16 |
| 1164940813 | Leonard Cerullo, Md, Ltd | Pain Medicine | 680 N Lake Shore Dr Ste 1428, Chicago, IL 60611-3461 | 2017-09-01 |
| 1417472887 | Kimberly Lynch | Pain Medicine | 5801 S Ellis Ave, Chicago, IL 60637-5418 | 2017-08-07 |
| 1598033953 | Manuel P. Blas | Pain Medicine | 1103 Berkley Ln, Lemont, IL 60439-8940 | 2011-12-13 |
| 1538356233 | Lake Shore Therapy Center, Inc. | Pain Medicine | 2338 W Morse Ave, 1 A, Chicago, IL 60645-4767 | 2007-09-27 |
| 1295811479 | Illinois Pain Treatment Institute, Ltd | Pain Medicine | 431 Summit, Elgin, IL 60120 | 2006-10-31 |
| 1164519005 | Wayne David Kelly | Pain Medicine | 1883 Hicks Rd, Suite A, Rolling Meadows, IL 60008-1254 | 2006-10-10 |
| 1417060146 | Ramesh Bathina | Pain Medicine | 1315 N Highland Ave # 105, Aurora, IL 60506-1400 | 2006-08-16 |
| 1457375115 | Terri L Dallas-prunskis | Pain Medicine | 4309 Medical Center Dr, B103, Mchenry, IL 60050 | 2006-07-26 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on REVITALIZE MEDICAL CENTER LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.