Individual
GADI ASHER REVIVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
355 E ERIE ST, CHICAGO, IL 60611-3167
(312) 238-1000
(312) 238-1208
Mailing address
355 E ERIE ST, CHICAGO, IL 60611-3167
(312) 238-1000
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
036-104471
IL
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
036-104471
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036104471-1
—
IL
Enumeration date
11/13/2006
Last updated
06/23/2022
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