Provider Demographics
NPI:1427066646
Name:LLOVET, MAGALIS (MD)
Entity type:Individual
Prefix:
First Name:MAGALIS
Middle Name:
Last Name:LLOVET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6622
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:3260 EAGLE PARK DR NE
Practice Address - Street 2:STE115
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-4569
Practice Address - Country:US
Practice Address - Phone:616-942-7400
Practice Address - Fax:616-942-7405
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIML075353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4255750Medicaid
MI700F374320OtherBCBS OF MI
MI700B510850OtherBCBS OF MI
MI4255750Medicaid
MID32325Medicare UPIN