Individual
MR. JUSTIN REVELO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LDN
Contact information
Practice address
1628 COUNTY ROAD 1950 N, CISNE, IL 62823-9037
(618) 571-4999
Mailing address
1628 COUNTY ROAD 1950 N, CISNE, IL 62823-9037
(618) 571-4999
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164.023666
IL
133V00000X
Registered Dietitian
37004542A
IN
Other
Enumeration date
06/08/2026
Last updated
06/08/2026
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