Provider Demographics
NPI:1841223120
Name:KAMMER, LAWRENCE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:
Last Name:KAMMER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 N EUCLID AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2483
Mailing Address - Country:US
Mailing Address - Phone:989-667-0491
Mailing Address - Fax:989-667-0493
Practice Address - Street 1:4175 N EUCLID AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2483
Practice Address - Country:US
Practice Address - Phone:989-667-0491
Practice Address - Fax:989-667-0493
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001072363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI010Z960170OtherBLUE CROSS BLUE SHIELD
MI0Z96017OtherMEDICARE PTAN
MI1366488728OtherFACILITY NPI
MIR66462Medicare UPIN
MI1366488728OtherFACILITY NPI