Healthcare Provider Details

I. General information

NPI: 1992954861
Provider Name (Legal Business Name): LIVITO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2008
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5028 46TH AVE
KENOSHA WI
53144-2025
US

IV. Provider business mailing address

5028 46TH AVE
KENOSHA WI
53144-2025
US

V. Phone/Fax

Practice location:
  • Phone: 773-837-4258
  • Fax:
Mailing address:
  • Phone: 773-837-4258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0207X
TaxonomyMobile Mammography Clinic/Center
License Number398056
License Number StateWI

VIII. Authorized Official

Name: MR. VITO CIPARIS
Title or Position: CEO
Credential: MBA, RT (R)
Phone: 773-837-4258