Provider Demographics
NPI:1457521296
Name:BLAU, LARRY LEWIS (DO)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:LEWIS
Last Name:BLAU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28119 DANVERS DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-4247
Mailing Address - Country:US
Mailing Address - Phone:248-855-1144
Mailing Address - Fax:
Practice Address - Street 1:28119 DANVERS DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-4247
Practice Address - Country:US
Practice Address - Phone:248-855-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010056712083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine