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

Revive Skin Institute LLC

Organization Dermatology Physician · NPI 1104178144

Revive Skin Institute LLC is a Dermatology Physician in Carbondale, Illinois. Licensed in Illinois. Registered with an NPI since 2012.

Licensed in
IL
In the registry since
2012
Specialties on file
2
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

1175 Cedar CT Carbondale
Carbondale, IL 62901-5333
Phone: (619) 549-0300
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Procedural Dermatology Physician (primary) Taxonomy 207NS0135X · Licence 036094335 (IL)
Dermatology Physician Taxonomy 207N00000X · Licence 036094335 (IL)

Record details

NPI number1104178144
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Anup Chaudhry — Member · (618) 549-0300
Other names Dermatology
NPI enumeratedOctober 14, 2012
Last updated in NPPESOctober 14, 2012
Mailing address1175 Cedar Ct, Carbondale, Carbondale, IL 62901-5333

Other providers in Carbondale