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NPI Code Detail

MEDICARE: DR. TODD THORNTON LAVERY M.D.

MEDICARE: DR. TODD THORNTON LAVERY M.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
1208600000XSurgery Physician4301090570MI

General Provider Information

NPI Number : 1497995641
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TODD THORNTON LAVERY M.D.
Provider Business Mailing Address
First Line : 1560 E MAPLE RD
Second Line : SUITE 400- CREDENTIALING DEPARTMENT
City : TROY
State : MI
Zip : 48083-1138
Country : US
Telephone Number : 248-581-5974
Fax Number : 248-581-5640
Provider Business Practice Location Address
First Line : 4160 JOHN R ST STE 615
Second Line :
City : DETROIT
State : MI
Zip : 48201-2022
Country : US
Telephone Number : 313-745-8773
Fax Number : 313-993-0595
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2009
Last Update Date : 05/06/2015

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