Healthcare Provider Details

I. General information

NPI: 1356330013
Provider Name (Legal Business Name): MICHAEL C SIVITZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 OLD YORK RD
ABINGTON PA
19001-4617
US

IV. Provider business mailing address

1047 OLD YORK RD
ABINGTON PA
19001-4617
US

V. Phone/Fax

Practice location:
  • Phone: 215-886-1240
  • Fax: 215-886-7591
Mailing address:
  • Phone: 215-886-1240
  • Fax: 215-886-7591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number011967-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: