Provider Demographics
NPI:1689137465
Name:MENCIA-LAWRENCE, MICHELE MARIE (DO)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:MARIE
Last Name:MENCIA-LAWRENCE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DRIVE
Mailing Address - Street 2:SUITE J2000
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:
Practice Address - Street 1:IHA HOSPITAL MEDICINE SERVICES
Practice Address - Street 2:5301 E HURON RIVER DRIVE
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-712-8676
Practice Address - Fax:734-712-8777
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-09
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101026908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine