Provider Demographics
NPI:1689671455
Name:LUM, LAWRENCE G (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:G
Last Name:LUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1420 STEPHENSON HWY
Mailing Address - Street 2:SUITE 400 - CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1189
Mailing Address - Country:US
Mailing Address - Phone:248-581-5977
Mailing Address - Fax:248-581-5640
Practice Address - Street 1:4100 JOHN R
Practice Address - Street 2:KARMANOS CANCER CENTER
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2013
Practice Address - Country:US
Practice Address - Phone:800-527-6266
Practice Address - Fax:313-576-8767
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2014-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIMD10207207RH0003X
MI4301054459207RH0003X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9021144Medicaid
RI9021144Medicaid
RIB54701Medicare UPIN
MI0P30630455Medicare PIN