Healthcare Provider Details

I. General information

NPI: 1902890411
Provider Name (Legal Business Name): ADONIS N LORENZANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19229 MACK AVE
GROSSE POINTE WOODS MI
48236-2858
US

IV. Provider business mailing address

43800 GARFIELD RD
CLINTON TWP MI
48038-1136
US

V. Phone/Fax

Practice location:
  • Phone: 800-848-0202
  • Fax: 586-226-6949
Mailing address:
  • Phone: 800-848-0202
  • Fax: 586-226-6949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number4301067154
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: