Provider Demographics
NPI:1386255487
Name:HEALTHY LIVING INTERNAL MEDICINE PLLC
Entity type:Organization
Organization Name:HEALTHY LIVING INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-227-6483
Mailing Address - Street 1:2300 HAGGERTY RD STE 2190
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2192
Mailing Address - Country:US
Mailing Address - Phone:248-960-1122
Mailing Address - Fax:248-246-0506
Practice Address - Street 1:2300 HAGGERTY RD STE 2190
Practice Address - Street 2:
Practice Address - City:W BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2192
Practice Address - Country:US
Practice Address - Phone:248-960-1122
Practice Address - Fax:248-246-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-12
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty