Provider Demographics
NPI:1497378145
Name:PREVENTIVE HEALTHCARE TECHNOLOGIES LLC
Entity Type:Organization
Organization Name:PREVENTIVE HEALTHCARE TECHNOLOGIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:H
Authorized Official - Last Name:SIWIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-463-9633
Mailing Address - Street 1:29560 BECK RD
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-2883
Mailing Address - Country:US
Mailing Address - Phone:833-463-9633
Mailing Address - Fax:
Practice Address - Street 1:29560 BECK RD
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-2883
Practice Address - Country:US
Practice Address - Phone:833-463-9633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-28
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory