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General NPI Number Information
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NPI Number | 1083371710
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Entity Type | Organization
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Legal Business Name | MICHAEL S KRIVITSKY DO PLLC
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Dates
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Enumeration Date | 11/17/2021
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Last Update Date | 01/06/2022
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Provider Practice Location Address
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Address Line | 22731 NEWMAN ST STE 120
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City | DEARBORN
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State | MI
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Zip | 48124-2043
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Country | US
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Telephone | 248-420-7389
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Fax |
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Provider Business Mailing Address
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Address Line | 4724 MAURA LN
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48323-3628
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Country | US
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Telephone | 248-420-7389
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MICHAEL S KRIVITSKY
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Credential | DO
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Telephone | 248-420-7389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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