Healthcare Provider Details

I. General information

NPI: 1770669210
Provider Name (Legal Business Name): KENNETH R LAWRENCE DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30335 W 13 MILE RD STE 100
FARMINGTON HILLS MI
48334
US

IV. Provider business mailing address

24300 ORCHARD LAKE RD
FARMINGTON HILLS MI
48336-1935
US

V. Phone/Fax

Practice location:
  • Phone: 248-476-1616
  • Fax: 248-476-6683
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: KENNETH RICHARD LAWRENCE
Title or Position: PHYSICIAN
Credential:
Phone: 248-476-1616