Healthcare Provider Details

I. General information

NPI: 1285208629
Provider Name (Legal Business Name): LAWRENCE GREENBERG DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 11 MILE RD
BERKLEY MI
48072-3050
US

IV. Provider business mailing address

PO BOX 33738 DEPT 999364
DETROIT MI
48232-3738
US

V. Phone/Fax

Practice location:
  • Phone: 248-399-0764
  • Fax:
Mailing address:
  • Phone: 248-933-4409
  • Fax: 248-661-9702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE GREENBERG
Title or Position: PHYSICIAN OWNER
Credential: DO
Phone: 248-828-7500