Individual
JOHN MARK REVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1435 WAUKEGAN RD, GLENVIEW, IL 60025-2120
(847) 832-6500
(847) 724-5379
Mailing address
2650 RIDGE AVE, EVANSTON HOSPITAL, EVANSTON, IL 60201-1718
(847) 570-1206
(847) 570-1248
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-080976
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110191370
RAILROAD MEDICARE PIN
IL
Enumeration date
12/08/2006
Last updated
10/06/2020
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