Individual
LAURENCE HABENICHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
42 N SAINT JOSEPH AVE, SUITE100, NILES, MI 49120-2203
(269) 684-6696
(269) 684-5286
Mailing address
42 N SAINT JOSEPH AVE, SUITE100, NILES, MI 49120-2203
(269) 684-6696
(269) 684-5286
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4301074430
MI
208600000X
Surgery Physician
4301074430
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
411815210
—
MI
Enumeration date
02/06/2006
Last updated
03/11/2016
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