Healthcare Provider Details

I. General information

NPI: 1306027073
Provider Name (Legal Business Name): LAWRENCE DESJARLAIS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 08/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CURTIS RD
ADRIAN MI
49221-1752
US

IV. Provider business mailing address

2000 CURTIS RD
ADRIAN MI
49221-1752
US

V. Phone/Fax

Practice location:
  • Phone: 517-264-5603
  • Fax: 517-264-5708
Mailing address:
  • Phone: 517-264-5603
  • Fax: 517-264-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301058635
License Number StateMI

VIII. Authorized Official

Name: DR. LAWRENCE JOHN DESJARLAIS
Title or Position: PHYSICIAN.OWNER
Credential: MD
Phone: 517-264-5603