Provider Demographics
NPI:1215125398
Name:ALLAN D. LAMB, D.O., P.C.
Entity type:Organization
Organization Name:ALLAN D. LAMB, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:DANA
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-676-4996
Mailing Address - Street 1:3851 WEST RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2350
Mailing Address - Country:US
Mailing Address - Phone:734-676-4996
Mailing Address - Fax:734-676-4407
Practice Address - Street 1:3851 WEST RD
Practice Address - Street 2:SUITE 3
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2350
Practice Address - Country:US
Practice Address - Phone:734-676-4996
Practice Address - Fax:734-676-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-14
Last Update Date:2007-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAL012651261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4230850Medicaid
02-5-82-0708-5OtherBCBS
15643OtherM-CARE
5820708OtherBCN PIN
MIH16049Medicare UPIN