Organization
REVIVE MEDICAL GROUP LLC
Active
Organization
REVIVE MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN CALVERT (CEO)
(317) 501-6826
Entity
Organization
Contact information
Practice address
7150 MADISON AVE, INDIANAPOLIS, IN 46227-5269
(317) 343-0334
(317) 348-3262
Mailing address
4312 S WOODBRIDGE LN, NEW PALESTINE, IN 46163-9579
(317) 501-6826
Taxonomy
Speciality
Code
Description
License number
State
207LA0401X
Addiction Medicine (Anesthesiology) Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
03/03/2020
Last updated
10/04/2021
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