Provider Demographics
NPI:1700845716
Name:DASCH, LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:DASCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:818 RIVERSIDE AVE
Mailing Address - Street 2:PO BOX 548
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1446
Mailing Address - Country:US
Mailing Address - Phone:517-265-0229
Mailing Address - Fax:517-265-0829
Practice Address - Street 1:331 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MI
Practice Address - Zip Code:49247-1051
Practice Address - Country:US
Practice Address - Phone:517-448-2371
Practice Address - Fax:517-448-7313
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301067142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI340946910Medicaid
MI382796005OtherTAX ID #
MI0D66025OtherBCBS