Healthcare Provider Details

I. General information

NPI: 1932150216
Provider Name (Legal Business Name): MICHELLE L. LENZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE L. ODENS M.D.

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 W PINE LAKE DR
NEWAYGO MI
49337-8029
US

IV. Provider business mailing address

100 MICHIGAN ST NE MC 845
GRAND RAPIDS MI
49503-2560
US

V. Phone/Fax

Practice location:
  • Phone: 231-652-1631
  • Fax: 231-652-1733
Mailing address:
  • Phone: 231-924-4200
  • Fax: 231-924-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number071233
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: