Organization
REVITALIZE IV SOLUTIONS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAWN BELVIS MD (OWNER)
(773) 417-4556
Entity
Organization
Contact information
Practice address
7237 W IRVING PARK RD, CHICAGO, IL 60634-3546
(773) 417-4556
(855) 958-5430
Mailing address
7237 W IRVING PARK RD, CHICAGO, IL 60634-3546
(773) 417-4556
(855) 958-5430
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12345678
INFUSION CLINIC
IL
Enumeration date
06/18/2021
Last updated
08/05/2021
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