Organization
DR. REVIVAJENNZ MED SPA, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER THOMAS-GOERING DO (MEDICAL DIRECTOR)
(734) 355-3566
Entity
Organization
Contact information
Practice address
418 S WAGNER RD, ANN ARBOR, MI 48103-1944
(734) 355-3566
Mailing address
4870 BIRKDALE DR, ANN ARBOR, MI 48103-9743
(734) 355-3566
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
02/07/2023
Last updated
02/07/2023
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