Provider Demographics
NPI:1487637195
Name:LAWRENCE USHER DO PC
Entity Type:Organization
Organization Name:LAWRENCE USHER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:USHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-929-2988
Mailing Address - Street 1:PO BOX 250943
Mailing Address - Street 2:
Mailing Address - City:W BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48325-0943
Mailing Address - Country:US
Mailing Address - Phone:586-929-2988
Mailing Address - Fax:586-929-2988
Practice Address - Street 1:3595 WABEEK LAKE DR W
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-1269
Practice Address - Country:US
Practice Address - Phone:586-929-2988
Practice Address - Fax:586-929-2988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI005506207Q00000X
MI4301069572207R00000X
MI083559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1011949Medicaid
MI0F36316OtherBCBS OF MI
MI1011949Medicaid
MI0F36316Medicare PIN