Healthcare Provider Details

I. General information

NPI: 1992734727
Provider Name (Legal Business Name): SYLVIA L LOVING D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 W MCNICHOLS RD
DETROIT MI
48219-4162
US

IV. Provider business mailing address

PO BOX 1845
DEARBORN MI
48121-1845
US

V. Phone/Fax

Practice location:
  • Phone: 313-532-1111
  • Fax: 313-532-1112
Mailing address:
  • Phone: 313-532-1111
  • Fax: 313-532-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSL002009
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: