Provider Demographics
NPI:1366445173
Name:EILENDER, LAWRENCE MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:MARK
Last Name:EILENDER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:26400 W 12 MILE RD
Mailing Address - Street 2:STE 170
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1753
Mailing Address - Country:US
Mailing Address - Phone:248-208-8787
Mailing Address - Fax:248-208-8788
Practice Address - Street 1:26400 W 12 MILE RD
Practice Address - Street 2:STE 170
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1753
Practice Address - Country:US
Practice Address - Phone:248-208-8787
Practice Address - Fax:248-208-8788
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-09-25
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Provider Licenses
StateLicense IDTaxonomies
MI4300409792084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2682910-10Medicaid
MIB46590Medicare UPIN