Provider Demographics
NPI:1881400323
Name:REVIVE MED PARTNERS I LLC
Entity type:Organization
Organization Name:REVIVE MED PARTNERS I LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KALRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-236-7060
Mailing Address - Street 1:2570 JUSTIN RD STE 160
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3055
Mailing Address - Country:US
Mailing Address - Phone:972-236-7060
Mailing Address - Fax:
Practice Address - Street 1:2570 JUSTIN RD STE 160
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-3055
Practice Address - Country:US
Practice Address - Phone:972-236-7060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty