Organization
LIFE INTEGRATIVE MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY REVELL MD (OWNER/PROVIDER)
(323) 216-0993
Entity
Organization
Contact information
Practice address
2018 EASTWOOD RD, WILMINGTON, NC 28403-7228
(910) 787-1358
(910) 344-0379
Mailing address
2018 EASTWOOD RD, WILMINGTON, NC 28403-7228
(910) 787-1358
(910) 344-0379
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
2084B0002X
Obesity Medicine (Psychiatry & Neurology) Physician
—
—
2084P0005X
Neurodevelopmental Disabilities Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
2084P0805X
Geriatric Psychiatry Physician
—
—
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
—
—
2084S0010X
Sports Medicine (Psychiatry & Neurology) Physician
—
—
Other
Enumeration date
11/26/2019
Last updated
11/26/2019
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