Provider Demographics
NPI:1477765618
Name:LIVINGSTON MEDICAL CENTER PC
Entity Type:Organization
Organization Name:LIVINGSTON MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MORELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-227-1200
Mailing Address - Street 1:1203 ARBOR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1900
Mailing Address - Country:US
Mailing Address - Phone:810-623-3559
Mailing Address - Fax:
Practice Address - Street 1:5865 WHITMORE LAKE ROAD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1900
Practice Address - Country:US
Practice Address - Phone:810-227-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010080742083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5471514Medicare ID - Type Unspecified