MEDICARE: DR. LAWRENCE LIVERNOIS JOSEPH MACDONALD MD

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	207RP1001X	Pulmonary Disease Physician	4301054690	MI
2	207RS0012X	Sleep Medicine (Internal Medicine) Physician	LM054690	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104868967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE LIVERNOIS JOSEPH MACDONALD MD

Provider Business Mailing Address
First Line	:	PO BOX 930349
Second Line	:
City	:	WIXOM
State	:	MI
Zip	:	48393-0349
Country	:	US
Telephone Number	:
Fax Number	:	248-543-9005

Provider Business Practice Location Address
First Line	:	5220 HIGHLAND RD STE 240
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48327-1973
Country	:	US
Telephone Number	:	248-237-6580
Fax Number	:

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	11/05/2025

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