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

Revive MD PLLC

Organization Family Medicine Physician · NPI 1346832953

Revive MD PLLC is a Family Medicine Physician in Saint Paul, Minnesota. Registered with an NPI since 2021.

In the registry since
2021
Specialties on file
3
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

821 Raymond Ave Ste 230
Saint Paul, MN 55114-1503
Phone: (651) 746-4412
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Interventional Pain Medicine Physician (primary) Taxonomy 208VP0014X
Family Medicine Physician Taxonomy 207Q00000X
Substance Use Disorder Rehabilitation Clinic/Center Taxonomy 261QR0405X

Record details

NPI number1346832953
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Alfonso Morales — Owner · (651) 476-4412
NPI enumeratedFebruary 4, 2021
Last updated in NPPESFebruary 4, 2021
Certification dateFebruary 4, 2021
Mailing address7595 Currell Blvd Unit 25404, Woodbury, MN 55125-2569

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