Provider Demographics
NPI:1124008842
Name:RAPP, LAWRENCE G (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:G
Last Name:RAPP
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 1:7650 DIXIE HWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2078
Mailing Address - Country:US
Mailing Address - Phone:248-620-9310
Mailing Address - Fax:248-620-9311
Practice Address - Street 1:7650 DIXIE HWY
Practice Address - Street 2:SUITE 140
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2078
Practice Address - Country:US
Practice Address - Phone:248-620-9310
Practice Address - Fax:248-620-9311
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301404978207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0992212OtherHEALTH PLUS OF MICHIGAN
MI140005777OtherRAILROAD MEDICARE
MI700F318300OtherBLUE CROSS BLUE SHIELD
MI000000003417OtherCAPE HEALTH PLAN
MI0004632168OtherAETNA HEALTH PLANS
MIC5501OtherM-CARE
MI104339OtherPREFERRED CHOICES
MI3439520Medicaid
MIN37000001Medicare ID - Type UnspecifiedMEDICARE ID
MI3439520Medicaid