Individual
MR. THOMAS J REVITTE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
5010 GULL RD, STE A, KALAMAZOO, MI 49048-1093
(269) 226-8800
(269) 226-8804
Mailing address
5010 GULL RD, STE A, KALAMAZOO, MI 49048-1093
(269) 226-8800
(269) 226-8804
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
4704216398
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4546810
—
MI
01
—
50087018880
BLUE CROSS & BLUE SHIELD
MI
Enumeration date
05/12/2006
Last updated
07/09/2007
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