Individual
PAUL REVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1055 FEATHERSTONE RD, ROCKFORD, IL 61107-5904
(815) 227-1055
Mailing address
1055 FEATHERSTONE RD STE C, ROCKFORD, IL 61107-5904
(815) 227-1055
(815) 227-1006
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036067857
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036067857
—
IL
Enumeration date
07/17/2006
Last updated
03/16/2026
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