Provider Demographics
NPI:1093930794
Name:LAWRENCE A HANSEN MD PLC
Entity Type:Organization
Organization Name:LAWRENCE A HANSEN MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-382-0151
Mailing Address - Street 1:7445 ALLEN RD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-1993
Mailing Address - Country:US
Mailing Address - Phone:313-382-0151
Mailing Address - Fax:313-382-2189
Practice Address - Street 1:7445 ALLEN RD
Practice Address - Street 2:SUITE 190
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-1993
Practice Address - Country:US
Practice Address - Phone:313-382-0151
Practice Address - Fax:313-382-2189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301407500208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0825978OtherBLUE CROSS
MI0825978OtherBLUE CROSS
0N38310Medicare PIN