Individual
DR. LAWRENCE JOHN DESJARLAIS
Active
Individual
DR. LAWRENCE JOHN DESJARLAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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