Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | LH407112 | MI |
NPI | 1629078142 |
---|---|
Provider Name | Dr. Lawrence Hennessey |
First Address | Okemos, MI 48864-4208 |
Second Address | Okemos, MI 48864-4208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2005 |
Last Update Date | 22/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4744075 | (05) | MI |
E61883 | (02) |