Provider Demographics
NPI:1538226337
Name:DRS GILMORE LACIVITA & ASSOCIATES PC
Entity type:Organization
Organization Name:DRS GILMORE LACIVITA & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-926-6673
Mailing Address - Street 1:39525 W 14 MILE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377
Mailing Address - Country:US
Mailing Address - Phone:248-926-6673
Mailing Address - Fax:248-926-6683
Practice Address - Street 1:39525 W 14 MILE RD
Practice Address - Street 2:STE 101
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377
Practice Address - Country:US
Practice Address - Phone:248-926-6673
Practice Address - Fax:248-926-6683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty