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REVIVE SPORTS & SPINE MANAGEMENT
NPI 1679195465
Clinic/Center - Medical Specialty in Warren, MI

Active since May 14, 2020
27253 VAN DYKE AVE, WARREN, MI 48093(586) 486-4520 Get Directions Write a Review

NPPES record last updated: May 14, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Revive Sports & Spine Management NPPES

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

REVIVE SPORTS & SPINE MANAGEMENT (NPI 1679195465) is a healthcare organization registered as a medical specialty in Warren, Michigan and active in the NPI registry since May 2020. The organization lists Haroun Ali Fetteh, Doctor/owner, as its authorized official.

NPPES Registry Identity

NPI1679195465
Entity TypeOrganization
Primary Taxonomy261QM2500X
Legal Business NameREVIVE SPORTS & SPINE MANAGEMENT
Location Address27253 VAN DYKE AVEWarren, MI 48093-2858
Mailing AddressPo Box 7175Dearborn, MI 48121-7175 · (313) 790-3998
Phone(586) 486-4520
Organization SubpartNo
Authorized OfficialHaroun Ali FettehDoctor/owner · (313) 790-3998
Enumeration DateMay 14, 2020
NPPES CertifiedMay 14, 2020
✔ NPI 1679195465 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Medical SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM2500X
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
27253 VAN DYKE AVE, Warren, MI 48093
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Other Providers at the Same Location NPPES 3

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

ORTHOPEDIC PHYSICAL THERAPY AND REHABILITATION LLC
Clinic/Center (Physical Therapy)
27253 VAN DYKE AVE
WARREN, MI 48093
Macomb County (586) 459-5692
DR. MICHAEL JOHN GASIEWICZ D.C.
Chiropractor
27253 VAN DYKE AVE
WARREN, MI 48093
Macomb County (586) 459-5692
MICHIGAN LABORATORIES LLC
Clinical Medical Laboratory
27253 VAN DYKE AVE
WARREN, MI 48093
Macomb County (248) 557-3303

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 Sports & Spine Management's NPI number?

The NPI number for Revive Sports & Spine Management is 1679195465. It was assigned to this organization in the NPPES registry on May 14, 2020.

Where is Revive Sports & Spine Management located?

Revive Sports & Spine Management is located at 27253 Van Dyke Ave, Warren, MI 48093. The listed phone number is (586) 486-4520.

What is Revive Sports & Spine Management's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Medical Specialty, with taxonomy code 261QM2500X.

When was this NPI record last updated?

The NPPES record for Revive Sports & Spine Management was last updated on May 14, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.