Basic Information
| Provider Information | |||||||||
| NPI: | 1063677912 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIVONIA FAMILY PHYSICIANS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17800 NEWBURGH RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481522700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344649540 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1014 E GRAND RIVER AVE | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481161804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344649540 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2008 | ||||||||
| LastUpdateDate: | 07/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | SELZNICK | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7344649540 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.