Provider Demographics
NPI:1639177512
Name:LUBBERS, LAWRENCE MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:MICHAEL
Last Name:LUBBERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1210 GEMINI PLACE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-6110
Mailing Address - Country:US
Mailing Address - Phone:614-262-4263
Mailing Address - Fax:614-262-0822
Practice Address - Street 1:1210 GEMINI PLACE
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-6110
Practice Address - Country:US
Practice Address - Phone:614-262-4263
Practice Address - Fax:614-262-0822
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-03-9874-L207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0480528Medicaid
OH200005731Medicare PIN
OH0480528Medicaid
OHA80048Medicare UPIN