Organization
DAVID FIVENSON, M.D.DERMATOLOGY, PLLC
Active
Organization
DAVID FIVENSON, M.D.DERMATOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID FIVENSON MD (PRESIDENT)
(734) 222-9630
Entity
Organization
Contact information
Practice address
3200 W LIBERTY RD STE C5, ANN ARBOR, MI 48103-9746
(734) 222-9630
Mailing address
3200 W LIBERTY RD STE C5, ANN ARBOR, MI 48103-9746
(734) 222-9630
Taxonomy
Speciality
Code
Description
License number
State
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
Primary
DF404817
MI
207NS0135X
Procedural Dermatology Physician
Primary
DF404817
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DF404817
STATE LICENSE
MI
Enumeration date
05/29/2007
Last updated
03/25/2026
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