OrganizationActive
Revive Skin Institute LLC
NPI 1104178144 · Procedural Dermatology Physician · Carbondale, IL
Provider details
- NPI number
- 1104178144
- Entity type
- Organization
- Primary specialty
- Procedural Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Anup Chaudhry, Member(618) 549-0300
- License
- 036094335 (IL)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(79/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
13 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1175 Cedar Ct
Carbondale
Carbondale, IL 62901-5333
Phone: (619) 549-0300
Street-level locationGet directions
Mailing address
1175 Cedar Ct
Carbondale, IL 62901-5333
Other names (DBA / former)
- Doing business as
- Dermatology
Registry dates
- Enumerated
- 2012-10-14
- Last updated
- 2012-10-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.