Provider Demographics
NPI:1619948114
Name:FAMILY PRACTICE CENTRE OF LIVONIA, PC
Entity type:Organization
Organization Name:FAMILY PRACTICE CENTRE OF LIVONIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:MERRILL
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-464-9200
Mailing Address - Street 1:38253 ANN ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3432
Mailing Address - Country:US
Mailing Address - Phone:734-464-9200
Mailing Address - Fax:734-464-0017
Practice Address - Street 1:38253 ANN ARBOR RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3432
Practice Address - Country:US
Practice Address - Phone:734-464-9200
Practice Address - Fax:734-464-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0H26420Medicare PIN