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General NPI Number Information
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NPI Number | 1346060977
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Entity Type | Organization
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Legal Business Name | TRINITY HEALTH ACADEMIC INTERNAL MEDICINE-NORTHWEST LIVONIA
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 36475 FIVE MILE RD
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City | LIVONIA
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State | MI
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Zip | 48154-1971
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Country | US
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Telephone | 734-793-2470
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Fax |
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Provider Business Mailing Address
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Address Line | 37595 7 MILE RD STE 340
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City | LIVONIA
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State | MI
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Zip | 48152-1489
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Country | US
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Telephone | 734-793-2470
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Fax |
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Authorized Official
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Title or Position | GME ADMINISTRATOR
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Name | MR. VIKTOR LAPORTE
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Credential |
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Telephone | 734-343-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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