Individual
EUGENE WALTER LAVERONI JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
28100 GRAND RIVER AVE STE 200, FARMINGTON HILLS, MI 48336-5969
(947) 521-8829
(248) 471-8352
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
5101009202
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3020482
—
MI
01
—
500564
DMC
MI
01
—
P69099
BCN
MI
Enumeration date
10/03/2005
Last updated
11/17/2020
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