Healthcare Provider Details

I. General information

NPI: 1881302537
Provider Name (Legal Business Name): LOIS ONERVA SCZOMAK REGISTERED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2022
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36475 FIVE MILE RD STE 412
LIVONIA MI
48154-1971
US

IV. Provider business mailing address

23850 BUCKINGHAM ST
DEARBORN MI
48128-1632
US

V. Phone/Fax

Practice location:
  • Phone: 734-655-2868
  • Fax: 734-655-4254
Mailing address:
  • Phone: 313-300-6969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberNONE
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: