Provider Demographics
NPI:1336253996
Name:MYSLIWIEC, LAWRENCE WALTER (DO)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:WALTER
Last Name:MYSLIWIEC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4660 S HAGADORN RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5376
Mailing Address - Country:US
Mailing Address - Phone:517-884-4554
Mailing Address - Fax:517-884-4556
Practice Address - Street 1:4660 S HAGADORN RD
Practice Address - Street 2:SUITE 500
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5376
Practice Address - Country:US
Practice Address - Phone:517-884-4554
Practice Address - Fax:517-884-4556
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101007412207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4780803Medicaid
MIA79899Medicare UPIN
MI0P23290Medicare PIN
MI0P23290001Medicare PIN