Provider Demographics
NPI:1255786612
Name:LARES, NATALIE JOAN (DO)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:JOAN
Last Name:LARES
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:41000 WOODWARD AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-5092
Mailing Address - Country:US
Mailing Address - Phone:248-325-8857
Mailing Address - Fax:
Practice Address - Street 1:19000 ST JOES PKWY STE 310
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1477
Practice Address - Country:US
Practice Address - Phone:734-743-4540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010256932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry