MEDICARE: DR. LILJANA LICOVSKI DPM

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	213EP1101X	Primary Podiatric Medicine Podiatrist	5901001880	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	:	1568469500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LILJANA LICOVSKI DPM

Provider Business Mailing Address
First Line	:	19723 ALLEN ROAD
Second Line	:
City	:	BROWNSTOWN
State	:	MI
Zip	:	48183
Country	:	US
Telephone Number	:	734-479-8383
Fax Number	:	734-479-8382

Provider Business Practice Location Address
First Line	:	19723 ALLEN RD
Second Line	:
City	:	BROWNSTOWN TWP
State	:	MI
Zip	:	48183-1021
Country	:	US
Telephone Number	:	734-479-8383
Fax Number	:	734-479-8382

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

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	12/16/2013

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