Provider Demographics
NPI:1083371710
Name:MICHAEL S KRIVITSKY DO PLLC
Entity Type:Organization
Organization Name:MICHAEL S KRIVITSKY DO PLLC
Other - Org Name:MICHAEL S KRIVITSKY DO PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:KRIVITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-420-7389
Mailing Address - Street 1:4724 MAURA LN
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3628
Mailing Address - Country:US
Mailing Address - Phone:248-420-7389
Mailing Address - Fax:
Practice Address - Street 1:22731 NEWMAN ST STE 120
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2043
Practice Address - Country:US
Practice Address - Phone:248-420-7389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-17
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center