Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr Revivajennz Med Spa, PLLC

Organization Clinic/Center · NPI 1083310312

Dr Revivajennz Med Spa, PLLC is a Clinic/Center in Ann Arbor, Michigan. Registered with an NPI since 2023.

In the registry since
2023
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

418 S Wagner Rd
Ann Arbor, MI 48103-1944
Phone: (734) 355-3566
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinic/Center (primary) Taxonomy 261Q00000X

Record details

NPI number1083310312
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jennifer Thomas-Goering — Medical Director · (734) 355-3566
NPI enumeratedFebruary 7, 2023
Last updated in NPPESFebruary 7, 2023
Certification dateFebruary 7, 2023
Mailing address4870 Birkdale Dr, Ann Arbor, MI 48103-9743

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