Provider Demographics
NPI:1255447660
Name:VERLINDEN, LAURENCE J (MD)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:J
Last Name:VERLINDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2290
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54221-2290
Mailing Address - Country:US
Mailing Address - Phone:920-320-4500
Mailing Address - Fax:920-682-9378
Practice Address - Street 1:1650 S 41ST ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-7316
Practice Address - Country:US
Practice Address - Phone:920-320-4500
Practice Address - Fax:920-682-9378
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB57329OtherCIGNA
WI26067OtherTOUCHPOINT
WI390806395OtherCHAMPUS
WI390806395OtherWEA
WI39080639508OtherTRICARE
WI080071913OtherMEDICARE RAILROAD
WI30588300Medicaid
WI9309OtherNETWORK HEALTH
WI0000158646 02OtherUNITED HEALTH
WI080071913OtherMEDICARE RAILROAD
WI000638170Medicare ID - Type Unspecified