1. Home
  2. Directory
  3. Illinois
  4. Carbondale
  5. Dermatology
  6. NPI Profile

DERMATOLOGY
NPI 1104178144
Dermatology - Procedural Dermatology in Carbondale, IL

Active since October 14, 2012
1175 CEDAR CT, CARBONDALE, CARBONDALE, IL 62901(619) 549-0300 Get Directions Write a Review

NPPES record last updated: October 14, 2012. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Dermatology NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DERMATOLOGY (NPI 1104178144) is a healthcare organization registered as a procedural dermatology in Carbondale, Illinois and active in the NPI registry since October 2012. The organization lists Anup Kumar Chaudhry, Member, as its authorized official.

NPPES Registry Identity

NPI1104178144
Entity TypeOrganization
Primary Taxonomy207NS0135X
Legal Business NameREVIVE SKIN INSTITUTE LLC
Location Address1175 CEDAR CT, CARBONDALECarbondale, IL 62901-5333
Mailing Address1175 Cedar Ct, CarbondaleCarbondale, IL 62901-5333 · (619) 549-0300
Phone(619) 549-0300
Organization SubpartNo
Authorized OfficialAnup Kumar ChaudhryMember · (618) 549-0300
Enumeration DateOctober 14, 2012
✔ NPI 1104178144 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDermatology · Procedural DermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207NS0135X
License✔ Licensed in IL · 036094335
Definition
Procedural Dermatology, a subspecialty of Dermatology, encompassing a wide variety of surgical procedures and methods to remove or modify skin tissue for health or cosmetic benefit. These methods include scalpel surgery, laser surgery, chemical surgery, cryosurgery (liquid nitrogen), electrosurgery, aspiration surgery, liposuction, injection of filler substances, and Mohs micrographic controlled surgery (a special technique for the removal of growths, especially skin cancers).
Also ListedDermatologyTaxonomy 207N00000X · License 036094335 (IL)
1175 CEDAR CT, Carbondale, IL 62901
Open in Google Maps ↗

Other Names 1

Doing Business AsDermatology

Other Identifiers 2

Medicaid036094335IL
Medicare UPINC43899IL

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PEDIATRIC GROUP LLC
Clinic/Center (Rural Health)
1175 CEDAR CT
CARBONDALE, IL 62901
Jackson County (618) 993-0404
MONICA L NAGELE NP
Nurse Practitioner (Psychiatric/Mental Health)
1175 CEDAR CT
CARBONDALE, IL 62901
Jackson County (618) 490-1045
MRS. BINDU REDDY M.D.
Pediatrics
1175 CEDAR CT
CARBONDALE, IL 62901
Jackson County (618) 993-0404
MUKESH CHAUDHRY M.D.
Family Medicine
1175 CEDAR CT
CARBONDALE, IL 62901
Jackson County (618) 549-0300
CARBONDALE FAMILY MEDICINE,LLC
Family Medicine
1175 CEDAR CT
CARBONDALE, IL 62901
Jackson County (618) 549-0300
DR. ANUP K CHAUDHRY M.D.
Dermatology
1175 CEDAR CT
CARBONDALE, IL 62901
Jackson County (618) 549-0300

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Revive Skin Institute LLC's NPI number?

The NPI number for Revive Skin Institute LLC is 1104178144. It was assigned to this organization in the NPPES registry on October 14, 2012. The provider is doing business as Dermatology.

Where is Revive Skin Institute LLC located?

Revive Skin Institute LLC is located at 1175 Cedar Ct Carbondale, Carbondale, IL 62901. The listed phone number is (619) 549-0300.

What is Revive Skin Institute LLC's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in Procedural Dermatology, with taxonomy code 207NS0135X.

When was this NPI record last updated?

The NPPES record for Revive Skin Institute LLC was last updated on October 14, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.