Healthcare Provider Details

I. General information

NPI: 1619948114
Provider Name (Legal Business Name): FAMILY PRACTICE CENTRE OF LIVONIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38253 ANN ARBOR RD
LIVONIA MI
48150-3432
US

IV. Provider business mailing address

38253 ANN ARBOR RD
LIVONIA MI
48150-3432
US

V. Phone/Fax

Practice location:
  • Phone: 734-464-9200
  • Fax: 734-464-0017
Mailing address:
  • Phone: 734-464-9200
  • Fax: 734-464-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TROY MERRILL SMITH
Title or Position: PARTNER
Credential: DO
Phone: 734-464-9200