Provider Demographics
NPI:1033203674
Name:LIVINGSTON CENTER OF ALLERGY, SINUS & ASTHMA, PC
Entity Type:Organization
Organization Name:LIVINGSTON CENTER OF ALLERGY, SINUS & ASTHMA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBRACKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-227-0906
Mailing Address - Street 1:P O BOX 30516
Mailing Address - Street 2:DEPT 8650
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909-8016
Mailing Address - Country:US
Mailing Address - Phone:810-227-0906
Mailing Address - Fax:
Practice Address - Street 1:8546 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2326
Practice Address - Country:US
Practice Address - Phone:810-227-0906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAD060576207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104105851Medicaid
MIG11044Medicare UPIN
MI104105851Medicaid
MI0000000011065OtherCAPE HEALTH PLAN
MI0M72610001Medicare PIN
MIG11044Medicare UPIN
MI104105851Medicaid