Provider Demographics
NPI:1942921200
Name:REVENGE MEDICAL INC
Entity Type:Organization
Organization Name:REVENGE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDAGIC
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:702-690-1633
Mailing Address - Street 1:343 ELM ST STE 201
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4538
Mailing Address - Country:US
Mailing Address - Phone:775-470-6651
Mailing Address - Fax:775-622-0788
Practice Address - Street 1:343 ELM ST STE 201
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4538
Practice Address - Country:US
Practice Address - Phone:775-470-6651
Practice Address - Fax:775-622-0788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty