Healthcare Provider Details

I. General information

NPI: 1730409996
Provider Name (Legal Business Name): LIVONIA & LIMA FAMILY MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 03/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 WASHINGTON ST
LIVONIA NY
14487-9738
US

IV. Provider business mailing address

5 WASHINGTON ST PO BOX 160
LIVONIA NY
14487-9738
US

V. Phone/Fax

Practice location:
  • Phone: 585-472-5945
  • Fax: 888-459-2228
Mailing address:
  • Phone: 585-472-5945
  • Fax: 888-459-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS JULIAN WRIGHT WALTERS
Title or Position: OWNER
Credential: MD
Phone: 585-472-5945