Provider Demographics
NPI:1780630541
Name:LULENSKI, MICHAEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:LULENSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:32000 NORTHWESTERN HWY STE 215
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1570
Mailing Address - Country:US
Mailing Address - Phone:248-344-9110
Mailing Address - Fax:248-344-9111
Practice Address - Street 1:22731 NEWMAN ST STE 250
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1930
Practice Address - Country:US
Practice Address - Phone:248-344-9110
Practice Address - Fax:248-344-9111
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301072492085R0204X
IN01057286A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301071249OtherLICENSE
IN736860YMedicare PIN