Provider Demographics
NPI:1093710469
Name:GIVONY, SHAUL (PT)
Entity Type:Individual
Prefix:MR
First Name:SHAUL
Middle Name:
Last Name:GIVONY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4123 MARTIN RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-4151
Mailing Address - Country:US
Mailing Address - Phone:248-366-9170
Mailing Address - Fax:248-366-9176
Practice Address - Street 1:4123 MARTIN RD
Practice Address - Street 2:SUITE 201
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-4151
Practice Address - Country:US
Practice Address - Phone:248-366-9170
Practice Address - Fax:248-366-9176
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004474174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650F301990OtherBLUE CROSS BLUE SHIELD MI
MIP66149Medicare UPIN
MIN84780001Medicare ID - Type Unspecified