Organization
BARIATRIC SPECIALISTS OF ILLINOIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LAURENCE HENRY LENZ JR. (EXECUTIVE VICE PRESIDENT)
(734) 547-1114
Entity
Organization
Contact information
Practice address
1625 S STATE ST, BELVIDERE, IL 61008-5907
(815) 544-1360
(815) 547-5394
Mailing address
135 S PROSPECT ST, YPSILANTI, MI 48198-7914
(734) 547-1114
(734) 547-1145
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208200000X
Plastic Surgery Physician
Primary
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00432012
BCBS PROVIDER NUMBER
—
Enumeration date
07/22/2006
Last updated
09/11/2025
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