Organization
LORENZO FERGUSON MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KENYA M FIFE (OFFICE MANAGER)
(248) 569-4228
Entity
Organization
Contact information
Practice address
22250 PROVIDENCE DR, SUITE 201, SOUTHFIELD, MI 48075-4825
(248) 569-4228
Mailing address
22250 PROVIDENCE DR, SUITE 201, SOUTHFIELD, MI 48075-4825
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
LF040848
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720182066
TYPE I NPI
MI
Enumeration date
07/27/2010
Last updated
07/27/2010
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