Provider Demographics
NPI:1033328299
Name:LAFOND MEDICAL P C
Entity Type:Organization
Organization Name:LAFOND MEDICAL P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:LAFOND
Authorized Official - Suffix:
Authorized Official - Credentials:D,O
Authorized Official - Phone:810-227-1540
Mailing Address - Street 1:1036 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1806
Mailing Address - Country:US
Mailing Address - Phone:810-227-1540
Mailing Address - Fax:810-227-7852
Practice Address - Street 1:1036 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1806
Practice Address - Country:US
Practice Address - Phone:810-227-1540
Practice Address - Fax:810-227-7852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIB7509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE37577Medicare UPIN