Provider Demographics
NPI:1235131160
Name:LORENZ, BRIGITTE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIGITTE
Middle Name:
Last Name:LORENZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1492 MOMENTUM PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5314
Mailing Address - Country:US
Mailing Address - Phone:248-601-2688
Mailing Address - Fax:248-601-2689
Practice Address - Street 1:441 S LIVERNOIS RD
Practice Address - Street 2:#175
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2584
Practice Address - Country:US
Practice Address - Phone:248-601-2688
Practice Address - Fax:248-601-2689
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066962207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4707812Medicaid
MIG62634Medicare UPIN
MIOP10610Medicare ID - Type Unspecified