1285977066 NPI number — LAUREN MORELLI M,D,

Table of content: LAUREN MORELLI M,D, (NPI 1285977066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285977066 NPI number — LAUREN MORELLI M,D,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORELLI
Provider First Name:
LAUREN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M,D,
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLMQUIST
Provider Other First Name:
LAUREN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285977066
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
460 ORCHARDALE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48309-2246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-425-7409
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4201 SAINT ANTOINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201-2153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-745-5147
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  4301103454 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 4301103454 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)