Provider Demographics
NPI:1568459196
Name:GREENBERG, LAWRENCE A (DO)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:A
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:6933 BURTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3250
Mailing Address - Country:US
Mailing Address - Phone:248-661-9702
Mailing Address - Fax:248-661-9702
Practice Address - Street 1:115 E LONG LAKE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-5524
Practice Address - Country:US
Practice Address - Phone:248-828-7500
Practice Address - Fax:248-813-6511
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2008-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MILG009318207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5633655Medicare PIN
MIF06516Medicare UPIN
MI390007561Medicare PIN