Dr. Revivajennz Med Spa, PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

DR. REVIVAJENNZ MED SPA, PLLC

Practice address

418 S Wagner Rd
Ann Arbor, MI 48103-1944

Phone

(734) 355-3566

NPI assigned

Feb 7, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jennifer Thomas-Goering, DONPI 1053432831

Title

Medical Director

Phone

(734) 355-3566

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jennifer Marie Thomas-Goering, DO

  • Anesthesiology Physician
  • Ann Arbor, MI
  • NPI 1053432831
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1083310312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4870 BIRKDALE DR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481039743",
            "telephone_number": "734-355-3566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 S WAGNER RD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481031944",
            "telephone_number": "734-355-3566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. REVIVAJENNZ MED SPA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-07",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "THOMAS-GOERING",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "734-355-3566",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dr. Chris Popp, PC
• Dr. George Ash, D.D.S., M.S., P.C.
• Dr. Harneet Grewal, PLLC
• Dr. Karen-Lee Jones Stewart, D.D.S., P.L.L.C.
• Dr. Lu'S Nourishing Life, LLC
• Dr. Sue Anderson PLLC
• Aleksandar Filip Dragovic, MD
• Anne Drake, BS
• Arianna Drake, LLMSW
• Elizabeth A Drake, MD

• Clinic/Center in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.