Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | LL008800 | MI |
NPI | 1598713430 |
---|---|
Provider Name | Mr. Laran Johnathon Lerner |
First Address | Westland, MI 48186-5355 |
Second Address | Westland, MI 48186-5355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 08/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
113128216 | (05) | MI |
383170766 | COMMERCIAL (01) | MI |
700H213850 | BCBSM (01) | MI |
F07596 | (02) | MI |