Healthcare Provider Details

I. General information

NPI: 1982957239
Provider Name (Legal Business Name): LTR ADMINISTRATIVE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1349 S ROCHESTER RD SUITE 130
ROCHESTER HILLS MI
48307-3150
US

IV. Provider business mailing address

1349 S ROCHESTER RD SUITE 130
ROCHESTER HILLS MI
48307-3150
US

V. Phone/Fax

Practice location:
  • Phone: 248-759-5693
  • Fax:
Mailing address:
  • Phone: 248-759-5693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number4301051449
License Number StateMI

VIII. Authorized Official

Name: ROBERT LEVINE
Title or Position: PHYSICIAN
Credential: MD
Phone: 248-320-8102