Provider Demographics
NPI:1285208629
Name:LAWRENCE GREENBERG DO
Entity Type:Organization
Organization Name:LAWRENCE GREENBERG DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-828-7500
Mailing Address - Street 1:PO BOX 33738 DEPT 999364
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48232-3738
Mailing Address - Country:US
Mailing Address - Phone:248-933-4409
Mailing Address - Fax:248-661-9702
Practice Address - Street 1:2624 11 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-3050
Practice Address - Country:US
Practice Address - Phone:248-399-0764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty