Provider Demographics
NPI:1376535195
Name:ZABLOCKI, LAWRENCE P (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:P
Last Name:ZABLOCKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:25925 TELEGRAPH RD
Mailing Address - Street 2:210
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-2518
Mailing Address - Country:US
Mailing Address - Phone:248-746-3218
Mailing Address - Fax:248-746-3218
Practice Address - Street 1:37595 7 MILE RD
Practice Address - Street 2:250
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1003
Practice Address - Country:US
Practice Address - Phone:734-432-7723
Practice Address - Fax:734-432-7761
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2008-09-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301053347207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI276215410Medicaid
MI0M99100OtherINDIVIDUAL MEDCIARE NUMBER
MI0F36477017Medicare PIN
MI276215410Medicaid