Active NPI
Marilyn Lasovage, M.D.
- General Practice Physician
- Dearborn, MI
National Provider Identifier
1932524337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 4301037551
- Practice address
- 24911 Newton St
Dearborn, MI 48124-1557 - Phone
- (313) 562-6209
- NPI assigned
- Feb 22, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 4301037551 | MI | Primary |
Addresses
Primary practice location
24911 Newton St
Dearborn, MI 48124-1557
Mailing address
24911 Newton St
Dearborn, MI 48124-1557
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301037551 | MI | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393027200000",
"number": "1932524337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24911 NEWTON ST",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481241557"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24911 NEWTON ST",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481241557",
"telephone_number": "313-562-6209"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LASOVAGE",
"first_name": "MARILYN",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-02-22",
"last_updated": "2014-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MI",
"license": "4301037551",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.