Provider Demographics
NPI:1679386346
Name:LIVEA MEDICAL PLLC
Entity type:Organization
Organization Name:LIVEA MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:SPHR
Authorized Official - Phone:952-220-5578
Mailing Address - Street 1:3495 NORTHDALE BLVD NW STE 100
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-6713
Mailing Address - Country:US
Mailing Address - Phone:763-323-4127
Mailing Address - Fax:
Practice Address - Street 1:3495 NORTHDALE BLVD NW STE 100
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-6713
Practice Address - Country:US
Practice Address - Phone:763-210-2608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity MedicineGroup - Single Specialty