Provider Demographics
NPI:1669633129
Name:LITVINOV, SERGEY P (MD)
Entity Type:Individual
Prefix:DR
First Name:SERGEY
Middle Name:P
Last Name:LITVINOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 LESLIE DR
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2901
Mailing Address - Country:US
Mailing Address - Phone:954-362-7570
Mailing Address - Fax:954-362-7559
Practice Address - Street 1:2215 N MILITARY TRL STE B
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-2901
Practice Address - Country:US
Practice Address - Phone:561-932-4665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1019662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000445300Medicaid
FLBK050ZOtherMEDICARE PTAN