Provider Demographics
NPI:1063487411
Name:BERLANGA, LORENZO D (MD)
Entity Type:Individual
Prefix:
First Name:LORENZO
Middle Name:D
Last Name:BERLANGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4800 N SAGINAW RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2953
Mailing Address - Country:US
Mailing Address - Phone:989-631-4545
Mailing Address - Fax:989-631-9949
Practice Address - Street 1:4800 N SAGINAW RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-2953
Practice Address - Country:US
Practice Address - Phone:989-839-9937
Practice Address - Fax:989-839-9220
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072241207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00668265OtherRAILROAD MEDICARE
MI5318523Medicaid
MIOE66012011Medicare PIN
MIP00668265OtherRAILROAD MEDICARE