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NPI Code Detail

MEDICARE: DETROIT LIVERNOIS P.C.

MEDICARE: DETROIT LIVERNOIS P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist

General Provider Information

NPI Number : 1790982270
Entity Type Code : Organization
Provider Name (Legal Business Name) : DETROIT LIVERNOIS P.C.
Provider Business Mailing Address
First Line : 15510 LIVERNOIS AVE
Second Line :
City : DETROIT
State : MI
Zip : 48238-1343
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 15510 LIVERNOIS AVE
Second Line :
City : DETROIT
State : MI
Zip : 48238-1343
Country : US
Telephone Number : 313-863-2800
Fax Number :
Authorized Official
Title or Position : INSURANCE DIRECTOR
Name : MIKE COLE
Credential :
Telephone Number : 727-726-1611
Provider Enumeration Date : 06/28/2007
Last Update Date : 08/22/2020

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