Provider Demographics
NPI:1992813588
Name:LORENC, MAREK MICHAL (MD)
Entity type:Individual
Prefix:DR
First Name:MAREK
Middle Name:MICHAL
Last Name:LORENC
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3562 ROUND BARN CIR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-0179
Mailing Address - Country:US
Mailing Address - Phone:707-578-1900
Mailing Address - Fax:707-578-1111
Practice Address - Street 1:3562 ROUND BARN CIR
Practice Address - Street 2:SUITE 320
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-0179
Practice Address - Country:US
Practice Address - Phone:707-578-1900
Practice Address - Fax:707-578-1111
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2011-09-06
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Provider Licenses
StateLicense IDTaxonomies
CAG53057207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52423Medicare UPIN
CA00G530570Medicare PIN