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NPI Code Detail

MEDICARE: LIVONIA PALLIATIVE CARE P.L.L.C.

MEDICARE: LIVONIA PALLIATIVE CARE P.L.L.C.
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
1207QH0002XHospice and Palliative Medicine (Family Medicine) Physician4301070040MI

General Provider Information

NPI Number : 1447432794
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIVONIA PALLIATIVE CARE P.L.L.C.
Provider Business Mailing Address
First Line : 14100 NEWBURGH RD
Second Line :
City : LIVONIA
State : MI
Zip : 48154-5010
Country : US
Telephone Number : 724-953-6033
Fax Number :
Provider Business Practice Location Address
First Line : 14100 NEWBURGH RD
Second Line :
City : LIVONIA
State : MI
Zip : 48154-5010
Country : US
Telephone Number : 724-953-6033
Fax Number : 734-464-2035
Authorized Official
Title or Position : OWNER
Name : DR. JAMES SCOTT BOAL
Credential : M.D.
Telephone Number : 734-953-6033
Provider Enumeration Date : 11/28/2007
Last Update Date : 02/29/2008

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