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Revive Skin Institute LLC

Procedural Dermatology Physician in Carbondale, IL · enumerated 2012 · authorized official Anup Chaudhry, Member.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1104178144

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Registry record

Entity type Organization (Type 2)
Legal business name Revive Skin Institute LLC
Other name <Unavail>
Practice address 1175 Cedar Ct, Carbondale, Carbondale, IL, 62901
Phone (619) 549-0300
Enumeration date Oct 14, 2012
Last updated in NPPES Oct 14, 2012

Taxonomy & classification

207N00000X Dermatology Physician Allopathic & Osteopathic Physicians · License 036094335 (IL) Secondary
207NS0135X Procedural Dermatology Physician Allopathic & Osteopathic Physicians · License 036094335 (IL) Primary

Authorized official

Name Anup Chaudhry
Title Member
Phone (618) 549-0300

Other identifiers

Identifier Type State Issuer
036094335 Medicaid IL -

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

What is the NPI number for Revive Skin Institute LLC?
The NPI for Revive Skin Institute LLC is 1104178144, a Type 2 (organization) record in the CMS NPPES registry.
Who is the authorized official for Revive Skin Institute LLC?
NPPES lists Anup Chaudhry (Member) as the authorized official for this organization.

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2012-10-14.