Organization
PAUL REVIS MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL REVIS MD (PHYSICIAN)
(815) 227-1055
Entity
Organization
Contact information
Practice address
1055 FEATHERSTONE RD STE C, ROCKFORD, IL 61107-5904
(815) 227-1055
(815) 227-1006
Mailing address
1055 FEATHERSTONE RD STE C, ROCKFORD, IL 61107-5904
(815) 227-1055
(815) 227-1006
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036067857
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010132251
BCBS OF IL
IL
05
—
036067857
—
IL
Enumeration date
06/11/2007
Last updated
03/16/2026
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