Provider Demographics
NPI:1346285814
Name:ZAGER, LAWRENCE (DO)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:ZAGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1681
Mailing Address - Country:US
Mailing Address - Phone:248-348-1131
Mailing Address - Fax:248-348-1170
Practice Address - Street 1:215 E MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1681
Practice Address - Country:US
Practice Address - Phone:248-348-1131
Practice Address - Fax:248-348-1170
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101005507207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOH24978OtherBLUE CROSS BLUE SHIELD MI
MI2110600Medicaid
MIE33275Medicare UPIN
MIOH24978OtherBLUE CROSS BLUE SHIELD MI