Healthcare Provider Details

I. General information

NPI: 1568459196
Provider Name (Legal Business Name): LAWRENCE A GREENBERG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 02/08/2025
Certification Date: 02/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E LONG LAKE RD
TROY MI
48085-5524
US

IV. Provider business mailing address

6933 BURTONWOOD DR
WEST BLOOMFIELD MI
48322-3250
US

V. Phone/Fax

Practice location:
  • Phone: 248-828-7500
  • Fax: 248-813-6511
Mailing address:
  • Phone: 248-661-9702
  • Fax: 248-661-9702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number5101009318
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberLG009318
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: