Healthcare Provider Details

I. General information

NPI: 1114966587
Provider Name (Legal Business Name): LIVINGSTON INTERNAL MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 EULER RD
BRIGHTON MI
48114-6815
US

IV. Provider business mailing address

2209 EULER RD
BRIGHTON MI
48114-6815
US

V. Phone/Fax

Practice location:
  • Phone: 810-225-7960
  • Fax: 810-225-7961
Mailing address:
  • Phone: 810-225-7960
  • Fax: 810-225-7961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLL054305
License Number StateMI

VIII. Authorized Official

Name: DR. LINDA C LACHANCE
Title or Position: PRESIDENT
Credential: MD
Phone: 810-225-7960