Provider Demographics
NPI:1104868967
Name:MACDONALD, LAWRENCE LIVERNOIS JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:LIVERNOIS JOSEPH
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 930349
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-0349
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:248-543-9005
Practice Address - Street 1:5220 HIGHLAND RD STE 240
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1973
Practice Address - Country:US
Practice Address - Phone:248-237-6580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054690207RP1001X
MILM054690207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3309955Medicaid
MI0Q26270003Medicare PIN
MI3309955Medicaid