Provider Demographics
NPI:1598713430
Name:LERNER, LARAN JOHNATHON (DO)
Entity Type:Individual
Prefix:MR
First Name:LARAN
Middle Name:JOHNATHON
Last Name:LERNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1678 S MERRIMAN RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-5355
Mailing Address - Country:US
Mailing Address - Phone:734-721-0011
Mailing Address - Fax:734-721-0859
Practice Address - Street 1:1678 S MERRIMAN RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5355
Practice Address - Country:US
Practice Address - Phone:734-721-0011
Practice Address - Fax:734-721-0859
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILL008800204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI113128216Medicaid
MI700H213850OtherBCBSM
MI383170766OtherCOMMERCIAL
MIF07596Medicare UPIN