Healthcare Provider Details

I. General information

NPI: 1043149768
Provider Name (Legal Business Name): DIMITRIA ANNA LIOVAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24911 LITTLE MACK SUITE C
ST. CLAIR SHORES MI
48080
US

IV. Provider business mailing address

24911 LITTLE MACK SUITE C
ST. CLAIR SHORES MI
48080
US

V. Phone/Fax

Practice location:
  • Phone: 586-777-2050
  • Fax: 586-777-2189
Mailing address:
  • Phone: 586-777-2050
  • Fax: 586-777-2189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: