Provider Demographics
NPI:1407944747
Name:PROKOP, LAWRENCE LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:LEE
Last Name:PROKOP
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-381-6100
Mailing Address - Fax:517-381-6201
Practice Address - Street 1:3860 DOBIE RD
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3704
Practice Address - Country:US
Practice Address - Phone:517-381-6100
Practice Address - Fax:517-381-6201
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007980208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1407944747Medicaid
MI4487227Medicaid
MIC36082063Medicare PIN
MI1407944747Medicaid