Provider Demographics
NPI:1437345378
Name:EUGENE W LAVERONI JR DO PC
Entity Type:Organization
Organization Name:EUGENE W LAVERONI JR DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:W
Authorized Official - Last Name:LAVERONI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:248-290-2940
Mailing Address - Street 1:28080 GRAND RIVER AVE
Mailing Address - Street 2:STE 207N
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5966
Mailing Address - Country:US
Mailing Address - Phone:248-471-8829
Mailing Address - Fax:248-471-8352
Practice Address - Street 1:28080 GRAND RIVER AVE
Practice Address - Street 2:STE 207N
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5966
Practice Address - Country:US
Practice Address - Phone:248-471-8829
Practice Address - Fax:248-471-8352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P50110Medicare PIN