Healthcare Provider Details

I. General information

NPI: 1336195809
Provider Name (Legal Business Name): LPRLS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37399 GARFIELD RD SUITE 203
CLINTON TOWNSHIP MI
48036-3659
US

IV. Provider business mailing address

37399 GARFIELD RD SUITE 203
CLINTON TOWNSHIP MI
48036-3659
US

V. Phone/Fax

Practice location:
  • Phone: 586-228-2911
  • Fax: 586-228-2901
Mailing address:
  • Phone: 586-228-2911
  • Fax: 586-228-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAWN MCPHERSON
Title or Position: BILLING DEPARTMENT
Credential:
Phone: 586-228-3991