Revive Medical Group Mi PC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

REVIVE MEDICAL GROUP MI PC

Practice address

231 W Pine Lake Dr
Newaygo, MI 49337-9264

Phone

(203) 430-1321

NPI assigned

Aug 9, 2024

Organization subpart

No

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

Authorized official

Name

Omar Ziyadeh

Title

Ceo/Program Manager

Phone

(203) 430-1321

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1723161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723161600000",
    "number": "1679304893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 ROANOKE AVE",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068246124",
            "telephone_number": "203-430-1321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231 W PINE LAKE DR",
            "city": "NEWAYGO",
            "state": "MI",
            "postal_code": "493379264",
            "telephone_number": "203-430-1321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE MEDICAL GROUP MI PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-09",
        "last_updated": "2024-08-09",
        "certification_date": "2024-08-09",
        "status": "A",
        "authorized_official_last_name": "ZIYADEH",
        "authorized_official_first_name": "OMAR",
        "authorized_official_title_or_position": "CEO/PROGRAM MANAGER",
        "authorized_official_telephone_number": "203-430-1321"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Newaygo, MI
• Providers in Newaygo, MI by specialty
• Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2024; 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.