MEDICARE: MR. SHAUL GIVONY PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	5501004474	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	650F301990	OTHER	MI	BLUE CROSS BLUE SHIELD MI

General Provider Information

NPI Number	:	1093710469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAUL GIVONY PT

Provider Business Mailing Address
First Line	:	4123 MARTIN RD
Second Line	:	SUITE 201
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48390-4151
Country	:	US
Telephone Number	:	248-366-9170
Fax Number	:	248-366-9176

Provider Business Practice Location Address
First Line	:	4123 MARTIN RD
Second Line	:	SUITE 201
City	:	COMMERCE TOWNSHIP
State	:	MI
Zip	:	48390-4151
Country	:	US
Telephone Number	:	248-366-9170
Fax Number	:	248-366-9176

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	06/30/2008

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Directions to “ MR. SHAUL GIVONY PT” Practice Location

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