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Individual

DR. LAWRENCE JOHN DESJARLAIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2000 CURTIS RD, ADRIAN, MI 49221-1752
(517) 264-5603
Mailing address
2000 CURTIS RD, ADRIAN, MI 49221-1752
(517) 265-8970

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
4301058635
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
03756
PARAMOUNT ID
MI
01
0704603132
BC PROVIDER NUMBER
MI
01
104133
CARE CHOICES ID
MI
01
13151
GREAT LAKES HEALTH CARE
MI
05
3109892
MI
01
383220131
EMP TAX ID#
MI
01
4637500
AETNA US HEALTHCARE
MI
01
5865
HEALTH PLAN OF MICHIGAN
MI
01
LD058635
BC REFERRING PROV NUMBER
MI
Enumeration date
04/28/2006
Last updated
06/19/2020
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