Individual
LYDIA MARIE LASICHAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6621 W MAPLE RD, W BLOOMFIELD, MI 48322-3004
(248) 661-4700
(248) 661-6210
Mailing address
6621 W MAPLE RD, W BLOOMFIELD, MI 48322-2078
(248) 661-4700
(248) 661-6210
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
LL043767
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4388757-10
—
MI
Enumeration date
12/02/2005
Last updated
12/18/2009
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