Provider Demographics
NPI:1316028541
Name:MCMASTER, LAWRENCE J (DO)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:J
Last Name:MCMASTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1633
Mailing Address - Country:US
Mailing Address - Phone:734-647-5299
Mailing Address - Fax:
Practice Address - Street 1:2211 OLD EARHART RD STE 195
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2963
Practice Address - Country:US
Practice Address - Phone:734-615-9200
Practice Address - Fax:734-615-9205
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101011410207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1316028541Medicaid
MI0H17613537Medicare ID - Type Unspecified
MI3305876Medicaid