Healthcare Provider Details

I. General information

NPI: 1942941174
Provider Name (Legal Business Name): ANDRE LARS LORENZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2022
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 CHAMBERS RD
CARO MI
48723-9293
US

IV. Provider business mailing address

2000 CHAMBERS RD
CARO MI
48723-9293
US

V. Phone/Fax

Practice location:
  • Phone: 989-673-3191
  • Fax:
Mailing address:
  • Phone: 989-673-3191
  • Fax: 989-673-6749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101027966
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: