Provider Demographics
NPI:1407076243
Name:LIVONIA FAMILY PHYSICIANS, PC
Entity Type:Organization
Organization Name:LIVONIA FAMILY PHYSICIANS, PC
Other - Org Name:LFP LABORATORY
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SELZNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-464-9540
Mailing Address - Street 1:17800 NEWBURGH RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2700
Mailing Address - Country:US
Mailing Address - Phone:734-464-9540
Mailing Address - Fax:734-464-0438
Practice Address - Street 1:17800 NEWBURGH RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2700
Practice Address - Country:US
Practice Address - Phone:734-464-9540
Practice Address - Fax:734-464-0438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P45980Medicare PIN