Individual
JOHN P REVORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5320 MICHAELS DR, APPLETON, WI 54913-8446
(920) 882-8200
(920) 882-8210
Mailing address
5320 MICHAELS DR, APPLETON, WI 54913-8446
(920) 882-8200
(920) 882-8210
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
32952
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31795300
—
WI
Enumeration date
08/16/2005
Last updated
02/11/2013
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