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Organization

LAWRENCE M FALLAT DPM PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LAWRENCE MICHAEL FALLAT DPM (PRESIDENT)
(313) 389-2288
Entity
Organization

Contact information

Practice address
20555 ECORSE RD, TAYLOR, MI 48180-1992
(313) 389-2288
(313) 389-2286
Mailing address
20555 ECORSE RD, TAYLOR, MI 48180-1992
(313) 389-2288
(313) 389-2286

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
LF000848
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0H27018
BCBS PIN
MI
05
131352563
MI
Enumeration date
10/24/2006
Last updated
05/13/2009
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