Provider Demographics
NPI:1437116852
Name:DESJARLAIS, LAWRENCE JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOHN
Last Name:DESJARLAIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 CURTIS RD
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1752
Mailing Address - Country:US
Mailing Address - Phone:517-265-8970
Mailing Address - Fax:
Practice Address - Street 1:2000 CURTIS RD
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1752
Practice Address - Country:US
Practice Address - Phone:517-264-5603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058635207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4637500OtherAETNA US HEALTHCARE
MI0704603132OtherBC PROVIDER NUMBER
MI3109892Medicaid
MI383220131OtherEMP TAX ID#
MI03756OtherPARAMOUNT ID
MI104133OtherCARE CHOICES ID
MI13151OtherGREAT LAKES HEALTH CARE
MILD058635OtherBC REFERRING PROV NUMBER
MI5865OtherHEALTH PLAN OF MICHIGAN
MI4637500OtherAETNA US HEALTHCARE
MIF87871Medicare UPIN