Provider Demographics
NPI:1619001062
Name:BRIGITTE LORENZ MD PLLC
Entity Type:Organization
Organization Name:BRIGITTE LORENZ MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIGITTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-601-2688
Mailing Address - Street 1:1492 MOMENTUM PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60689-5314
Mailing Address - Country:US
Mailing Address - Phone:248-601-2688
Mailing Address - Fax:248-601-2689
Practice Address - Street 1:441 S LIVERNOIS RD
Practice Address - Street 2:SUITE 175
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2584
Practice Address - Country:US
Practice Address - Phone:248-601-2688
Practice Address - Fax:248-601-2689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066962207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC8415OtherMEDICARE RAILROAD
DC8415OtherMEDICARE RAILROAD