Provider Demographics
NPI:1811001407
Name:NETZLOFF, MICHAEL LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:NETZLOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B249 LIFE SCIENCES BLDG
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS AND HUMAN DEVELOPMENT
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824
Mailing Address - Country:US
Mailing Address - Phone:517-355-3308
Mailing Address - Fax:
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:STE 145
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-364-5440
Practice Address - Fax:517-364-5409
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301041738207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1320793Medicaid
MI1320793Medicaid
MI0C36092011Medicare PIN