Basic Information
| Provider Information | |||||||||
| NPI: | 1679544506 | ||||||||
| 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 | ||||||||
| FaxNumber: | 7344640438 | ||||||||
| Practice Location | |||||||||
| Address1: | 17800 NEWBURGH RD | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481522700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344649540 | ||||||||
| FaxNumber: | 7344640438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 10/19/2007 | ||||||||
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| AuthorizedOfficialLastName: | SELZNICK | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7342662780 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.