Active NPI
Lawrence B Prussack, MD
- Obstetrics & Gynecology Physician
- West Bloomfield, MI
National Provider Identifier
1962497248
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 4301043881
- Practice address
- 6900 Orchard Lake Rd
Ste 306
West Bloomfield, MI 48322-3405 - Phone
- (248) 855-6663
- Fax
- (248) 855-7546
- NPI assigned
- Sep 13, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 4301043881 | MI | Primary |
Addresses
Primary practice location
6900 Orchard Lake Rd
Ste 306
West Bloomfield, MI 48322-3405
Mailing address
6900 Orchard Lake Rd
Ste 311
West Bloomfield, MI 48322-3405
Phone (248) 855-6663
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2722284 | Medicaid | MI |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301043881 | MI | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michigan Healthcare Professionals PC | Past | Accepting new patients | |
| Michigan Womens Health Institute,PC | Obstetrics & Gynecology | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Durable Medical Equipment & Medical Supplies
- Lapeer, MI
- NPI 1992693303
-
- Obstetrics & Gynecology Physician
- West Bloomfield, MI
- NPI 1144206848
Obstetrics & Gynecology
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199318400000",
"number": "1962497248",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6900 ORCHARD LAKE RD",
"address_2": "STE 311",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483223405",
"telephone_number": "248-855-6663",
"fax_number": "248-855-7546"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6900 ORCHARD LAKE RD",
"address_2": "STE 306",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483223405",
"telephone_number": "248-855-6663",
"fax_number": "248-855-7546"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRUSSACK",
"first_name": "LAWRENCE",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-13",
"last_updated": "2008-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "MI",
"license": "4301043881",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2722284",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Bloomfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.