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General NPI Number Information
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NPI Number | 1215612437
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Entity Type | Individual
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Provider Name | SUZANNA IVANOVICS ND
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Gender | Female
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 38777 6 MILE RD STE 401
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City | LIVONIA
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State | MI
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Zip | 48152-2694
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Country | US
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Telephone | 724-779-1650
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Fax |
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Provider Business Mailing Address
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Address Line | 2322 LINWOOD AVE
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City | ROYAL OAK
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State | MI
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Zip | 48073-3871
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Country | US
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Telephone | 248-403-5544
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 21-00072
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License Number State | KS
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