Provider Demographics
NPI:1639184070
Name:LAPA, MARTIN W (DO)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:W
Last Name:LAPA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1595 GENESYS PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8068
Mailing Address - Country:US
Mailing Address - Phone:810-606-9190
Mailing Address - Fax:810-606-9400
Practice Address - Street 1:1595 GENESYS PKWY
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8068
Practice Address - Country:US
Practice Address - Phone:810-606-9190
Practice Address - Fax:810-606-9400
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101013854207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4410802Medicaid
MI4410802Medicaid
MIH63547Medicare UPIN