MEDICARE: DR. PAUL R SAVICKAS PH.D.

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	103TC0700X	Clinical Psychologist	6301005946	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0H24726	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1134163322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL R SAVICKAS PH.D.

Provider Business Mailing Address
First Line	:	14600 KING ROAD
Second Line	:
City	:	RIVERVIEW
State	:	MI
Zip	:	48193-7952
Country	:	US
Telephone Number	:	734-479-2708
Fax Number	:	734-479-2736

Provider Business Practice Location Address
First Line	:	14600 KING ROAD
Second Line	:
City	:	RIVERVIEW
State	:	MI
Zip	:	48193-7952
Country	:	US
Telephone Number	:	734-479-2708
Fax Number	:	734-479-2736

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	10/04/2011

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