NICOLAS JOSEPH REVELT MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125080666

License Status

ACTIVE

Business

Title

First Name

NICOLAS

Middle

JOSEPH

Last Name

REVELT

Business Name

NICOLAS JOSEPH REVELT MD

Original Issue Date

06/26/2025

Effective Date

06/26/2025

Expiration Date

06/25/2027

City

SPRINGFIELD

State

Zip

62701

County

SANGAMON

Specialty/Qualifier

Orthopaedic Surgery

Ever Disciplined

LastModifiedDate

03/17/2025