Healthcare Provider Details

I. General information

NPI: 1700845716
Provider Name (Legal Business Name): LAWRENCE DASCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 W MAIN ST
HUDSON MI
49247-1051
US

IV. Provider business mailing address

818 RIVERSIDE AVE PO BOX 548
ADRIAN MI
49221-1446
US

V. Phone/Fax

Practice location:
  • Phone: 517-448-2371
  • Fax: 517-448-7313
Mailing address:
  • Phone: 517-265-0229
  • Fax: 517-265-0829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301067142
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: