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General NPI Number Information
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NPI Number | 1992954861
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Entity Type | Organization
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Legal Business Name | LIVITO LLC
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Dates
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Enumeration Date | 09/15/2008
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Last Update Date | 09/15/2008
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Provider Practice Location Address
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Address Line | 5028 46TH AVE
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City | KENOSHA
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State | WI
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Zip | 53144-2025
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Country | US
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Telephone | 773-837-4258
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Fax |
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Provider Business Mailing Address
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Address Line | 5028 46TH AVE
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City | KENOSHA
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State | WI
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Zip | 53144-2025
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Country | US
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Telephone | 773-837-4258
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. VITO CIPARIS
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Credential | MBA, RT (R)
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Telephone | 773-837-4258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0207X
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Taxonomy Name | Mobile Mammography Clinic/Center
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License Number | 398056
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License Number State | WI
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