Organization
REVIVE MEDICAL GROUP MI PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OMAR ZIYADEH (CEO/PROGRAM MANAGER)
(203) 430-1321
Entity
Organization
Contact information
Practice address
231 W PINE LAKE DR, NEWAYGO, MI 49337-9264
(203) 430-1321
Mailing address
81 ROANOKE AVE, FAIRFIELD, CT 06824-6124
(203) 430-1321
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
08/09/2024
Last updated
08/09/2024
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