Individual
DR. JEFFREY ROBERT LUPOVITCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
29927 SIX MILE RD, LIVONIA, MI 48152
(734) 522-0800
(734) 522-1236
Mailing address
29927 SIX MILE RD, LIVONIA, MI 48152
(734) 522-0800
(734) 522-1236
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
4301079764
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104933152
—
MI
01
—
180F372960
BLUE CARE NETWORK
—
01
—
381867275
HARRINGTON BENEFITS
—
01
—
JL079764
STATE LICENSE
MI
01
—
OH24256
BLUE CROSS
MI
Enumeration date
06/16/2006
Last updated
04/21/2009
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