Provider Demographics
NPI:1174334619
Name:REVAMP HORMONE REPALCEMENT AND MEDICAL WEIGHT LOSS
Entity type:Organization
Organization Name:REVAMP HORMONE REPALCEMENT AND MEDICAL WEIGHT LOSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SRIKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KARANAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:513-373-9556
Mailing Address - Street 1:1027 E GREEN TREE CT APT C
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-2278
Mailing Address - Country:US
Mailing Address - Phone:513-373-9556
Mailing Address - Fax:
Practice Address - Street 1:161 S RIVERHEATH WAY STE 2600
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-8420
Practice Address - Country:US
Practice Address - Phone:513-373-9556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Single Specialty