Provider Demographics
NPI:1346060977
Name:TRINITY HEALTH ACADEMIC INTERNAL MEDICINE-NORTHWEST LIVONIA
Entity type:Organization
Organization Name:TRINITY HEALTH ACADEMIC INTERNAL MEDICINE-NORTHWEST LIVONIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GME ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VIKTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPORTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-343-1000
Mailing Address - Street 1:37595 7 MILE RD STE 340
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1489
Mailing Address - Country:US
Mailing Address - Phone:734-793-2470
Mailing Address - Fax:
Practice Address - Street 1:36475 FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1971
Practice Address - Country:US
Practice Address - Phone:734-793-2470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty