Provider Demographics
NPI:1952385700
Name:LEWERENZ, JAMES S (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:LEWERENZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2653
Mailing Address - Country:US
Mailing Address - Phone:248-548-3060
Mailing Address - Fax:248-548-3078
Practice Address - Street 1:1467 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2653
Practice Address - Country:US
Practice Address - Phone:248-548-3060
Practice Address - Fax:248-548-3078
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013482207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H217350OtherBLUE SHIELD
MIG82387OtherHAP
MI131589OtherCARE-PREFERRED CHOICES
MI1952385700Medicaid
MI5631232OtherBCBS INDIVIDUAL
MI700H217350OtherBLUE SHIELD
MI1952385700Medicaid