Healthcare Provider Details

I. General information

NPI: 1669633129
Provider Name (Legal Business Name): SERGEY P LITVINOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 N MILITARY TRL STE B
WEST PALM BEACH FL
33409-2901
US

IV. Provider business mailing address

521 LESLIE DR
HALLANDALE BEACH FL
33009-2901
US

V. Phone/Fax

Practice location:
  • Phone: 561-932-4665
  • Fax:
Mailing address:
  • Phone: 954-362-7570
  • Fax: 954-362-7559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME101966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: