Healthcare Provider Details

I. General information

NPI: 1184735300
Provider Name (Legal Business Name): ANUP LAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 PINE GROVE AVE STE 2F
PORT HURON MI
48060-3500
US

IV. Provider business mailing address

1231 PINE GROVE AVE STE 2F
PORT HURON MI
48060-3500
US

V. Phone/Fax

Practice location:
  • Phone: 810-982-5200
  • Fax: 810-982-9776
Mailing address:
  • Phone: 810-982-5200
  • Fax: 810-982-9776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4301070625
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: