Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301050925 | MI |
N | 111NI0900X | Internist | 4301050925 | MI |
N | 207RX0202X | Medical Oncology | 4301050925 | MI |
NPI | 1144312547 |
---|---|
Provider Name | Theodore S Lawrence |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 13/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3453959 | (05) | MI |
B49063 | (02) | MI |