Healthcare Provider Details

I. General information

NPI: 1598713430
Provider Name (Legal Business Name): LARAN JOHNATHON LERNER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1678 S MERRIMAN RD
WESTLAND MI
48186-5355
US

IV. Provider business mailing address

1678 S MERRIMAN RD
WESTLAND MI
48186-5355
US

V. Phone/Fax

Practice location:
  • Phone: 734-721-0011
  • Fax: 734-721-0859
Mailing address:
  • Phone: 734-721-0011
  • Fax: 734-721-0859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberLL008800
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: