Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 4301032751 | MI |
NPI | 1164482824 |
---|---|
Provider Name | Robert Lorenz |
First Address | Royal Oak, MI 48073-6712 |
Second Address | Royal Oak, MI 48073-6710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 22/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1541337 | (05) | MI |
160F376970 | BCBSM (01) | MI |
B48835 | (02) | MI |