Provider Demographics
NPI:1962625053
Name:EDWARD S. LERCHIN MD PC
Entity type:Organization
Organization Name:EDWARD S. LERCHIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:LERCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-566-6770
Mailing Address - Street 1:45710 SCHOENHERR RD
Mailing Address - Street 2:SUITE #10
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-6033
Mailing Address - Country:US
Mailing Address - Phone:586-566-6770
Mailing Address - Fax:586-566-6772
Practice Address - Street 1:45710 SCHOENHERR RD
Practice Address - Street 2:SUITE #10
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-6033
Practice Address - Country:US
Practice Address - Phone:586-566-6770
Practice Address - Fax:586-566-6772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301030015207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P54790Medicare PIN
MIA73494Medicare UPIN