Provider Demographics
NPI:1891788865
Name:SARAVOLATZ, LOUIS D (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:D
Last Name:SARAVOLATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:43800 GARFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1136
Mailing Address - Country:US
Mailing Address - Phone:586-228-4635
Mailing Address - Fax:586-228-4520
Practice Address - Street 1:19251 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2893
Practice Address - Country:US
Practice Address - Phone:313-343-7280
Practice Address - Fax:313-343-7921
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301036402207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
4301036402OtherCONTROLLED SUBSTANCE
MI3300922Medicaid
4301036402OtherCONTROLLED SUBSTANCE
B48201Medicare UPIN