Healthcare Provider Details

I. General information

NPI: 1154546950
Provider Name (Legal Business Name): LAWRENCE ALAN MARTEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35425 W MICHIGAN AVE
WAYNE MI
48184-1687
US

IV. Provider business mailing address

35425 W MICHIGAN AVE
WAYNE MI
48184-1687
US

V. Phone/Fax

Practice location:
  • Phone: 734-722-4816
  • Fax: 734-467-7626
Mailing address:
  • Phone: 734-722-4816
  • Fax: 734-467-7626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301041009
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: