Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301066065 | MI |
N | 208600000X | Surgeon | 4301066065 | MI |
N | 2082S0105X | Plastic Hand Surgeon | 4301066065 | MI |
NPI | 1891743712 |
---|---|
Provider Name | Dr. Lawrence Tong |
First Address | Bingham Farms, MI 48025-2442 |
Second Address | Bingham Farms, MI 48025-2442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2406345262 | BCBS MICHIGAN (01) | MI |
H70758 | (02) | MI |