Provider Demographics
NPI:1912237512
Name:LOUIS D SOVERINSKY D.O. PLLC
Entity type:Organization
Organization Name:LOUIS D SOVERINSKY D.O. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:SOVERINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-334-2311
Mailing Address - Street 1:1701 BALDWIN AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48340-3412
Mailing Address - Country:US
Mailing Address - Phone:248-334-2311
Mailing Address - Fax:248-334-6738
Practice Address - Street 1:1701 BALDWIN AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48340-3412
Practice Address - Country:US
Practice Address - Phone:248-334-2311
Practice Address - Fax:248-334-6738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005076261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4094758Medicaid
MI0M83310Medicare PIN
E26321Medicare UPIN