MEDICARE: DR. BRIGITTE LORENZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	4301066962	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235131160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIGITTE LORENZ MD

Provider Business Mailing Address
First Line	:	1492 MOMENTUM PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60689-5314
Country	:	US
Telephone Number	:	248-601-2688
Fax Number	:	248-601-2689

Provider Business Practice Location Address
First Line	:	441 S LIVERNOIS RD
Second Line	:	#175
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-2584
Country	:	US
Telephone Number	:	248-601-2688
Fax Number	:	248-601-2689

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/21/2011

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