Provider Demographics
NPI:1154546950
Name:MARTEN, LAWRENCE ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ALAN
Last Name:MARTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:35425 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1687
Mailing Address - Country:US
Mailing Address - Phone:734-722-4816
Mailing Address - Fax:734-467-7626
Practice Address - Street 1:35425 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1687
Practice Address - Country:US
Practice Address - Phone:734-722-4816
Practice Address - Fax:734-467-7626
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301041009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA79377Medicare UPIN