Provider Demographics
NPI:1316028400
Name:LIVIERATOS, MARIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:LIVIERATOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:LIVIERATOS-DOBBINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1501 WATERFORD PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-9631
Mailing Address - Country:US
Mailing Address - Phone:989-534-2353
Mailing Address - Fax:989-534-2352
Practice Address - Street 1:1501 WATERFORD PKWY STE B
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-9631
Practice Address - Country:US
Practice Address - Phone:989-534-2353
Practice Address - Fax:989-534-2352
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064240207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1316028400Medicaid
MIH09333Medicare UPIN
MI4301064240OtherBOARD OF MEDICINE LICENSE