Provider Demographics
NPI:1144228214
Name:LAVINE, DAVID ALAN (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:LAVINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26400 OUTER DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-2088
Mailing Address - Country:US
Mailing Address - Phone:313-594-6000
Mailing Address - Fax:
Practice Address - Street 1:26400 OUTER DR
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2088
Practice Address - Country:US
Practice Address - Phone:313-594-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010468207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4490527Medicaid
F27412Medicare UPIN
MI4490527Medicaid