Provider Demographics
NPI:1710219407
Name:DAVID M VIVIANO MD ORTHOPAEDIC SURGERY PLC
Entity type:Organization
Organization Name:DAVID M VIVIANO MD ORTHOPAEDIC SURGERY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:VIVIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-247-0100
Mailing Address - Street 1:PO BOX 22958
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44122-0958
Mailing Address - Country:US
Mailing Address - Phone:216-595-9600
Mailing Address - Fax:216-595-9601
Practice Address - Street 1:42950 SCHOENHERR RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-2852
Practice Address - Country:US
Practice Address - Phone:586-247-0100
Practice Address - Fax:586-247-1350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060296207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHG97179Medicare UPIN