Organization
REVITA LIFE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDRE R NUNN M.D. (PRESIDENT)
(313) 745-7454
Entity
Organization
Contact information
Practice address
4106 JOHN R, SUITE 805, DETROIT, MI 48201
(313) 745-7454
(313) 993-8625
Mailing address
4106 JOHN R, SUITE 805, DETROIT, MI 48201
(313) 745-7454
(313) 993-8625
Taxonomy
Speciality
Code
Description
License number
State
132700000X
Dietary Manager
Primary
AN066667
MI
Other
Enumeration date
09/26/2006
Last updated
08/22/2020
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