Preventive Healthcare Technologies LLC

Primary specialty

Physiological LaboratoryTaxonomy code 293D00000X

Legal business name

PREVENTIVE HEALTHCARE TECHNOLOGIES LLC

Practice address

29560 Beck Rd
Wixom, MI 48393-2883

Phone

(833) 463-9633

NPI assigned

May 28, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dominic H Siwik

Title

Ceo

Phone

(833) 463-9633

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682294400000",
    "number": "1497378145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29560 BECK RD",
            "city": "WIXOM",
            "state": "MI",
            "postal_code": "483932883",
            "telephone_number": "833-463-9633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29560 BECK RD",
            "city": "WIXOM",
            "state": "MI",
            "postal_code": "483932883",
            "telephone_number": "833-463-9633"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 Sigma Dr Ste 300",
            "address_purpose": "LOCATION",
            "city": "Summerville",
            "state": "SC",
            "postal_code": "294867722",
            "country_code": "US",
            "telephone_number": "313-655-5400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6047 Tyvola Glen Cir",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282176431",
            "country_code": "US",
            "telephone_number": "313-655-5400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PREVENTIVE HEALTHCARE TECHNOLOGIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-28",
        "last_updated": "2023-04-24",
        "certification_date": "2023-04-24",
        "status": "A",
        "authorized_official_last_name": "SIWIK",
        "authorized_official_first_name": "DOMINIC",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "833-463-9633"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physiological Laboratory in Wixom, MI
• Providers in Wixom, MI by specialty
• Physiological Laboratory in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.