Healthcare Provider Details

I. General information

NPI: 1891788865
Provider Name (Legal Business Name): LOUIS D SARAVOLATZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19251 MACK AVE
GROSSE POINTE WOODS MI
48236-2893
US

IV. Provider business mailing address

43800 GARFIELD RD
CLINTON TOWNSHIP MI
48038-1136
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-7280
  • Fax: 313-343-7921
Mailing address:
  • Phone: 586-228-4635
  • Fax: 586-228-4520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number4301036402
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: