# REVIVE HEALTH MEDICAL WEIGHT LOSS & WELLNESS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053168948
- **Authorized official:** DR. KAISA SCHMITZ DO (OWNER)
- **Authorized official phone:** (952) 243-5628

## Contact information

- **Practice address:** 10627 165TH ST W, LAKEVILLE, MN 55044-3517
- **Practice address phone:** (952) 243-5628
- **Mailing address:** 10627 165TH ST W, LAKEVILLE, MN 55044-3517

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QB0002X | Obesity Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QB0002X | Obesity Medicine (Family Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/30/2024
- **Last updated:** 10/01/2024