Provider Demographics
NPI:1891722740
Name:LAVIGNE, SUZETTE D (MD)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:D
Last Name:LAVIGNE
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR
Mailing Address - Street 2:PO BOX 0446, LOBBY J
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9484
Mailing Address - Country:US
Mailing Address - Phone:734-747-6766
Mailing Address - Fax:734-222-3100
Practice Address - Street 1:111 N HURON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-2676
Practice Address - Country:US
Practice Address - Phone:734-547-7977
Practice Address - Fax:734-547-7978
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-01-22
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Provider Licenses
StateLicense IDTaxonomies
MI4301068041207R00000X, 208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4251125Medicaid
MI4251125Medicaid
MIN2000061Medicare PIN