Provider Demographics
NPI:1902925621
Name:MICHAEL W. LAUERMANN, M.D. A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MICHAEL W. LAUERMANN, M.D. A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:MICHAEL W. LAUERMANN M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WELING
Authorized Official - Last Name:LAUERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-799-9500
Mailing Address - Street 1:16835 ALGONQUIN ST
Mailing Address - Street 2:SUITE 490
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-3810
Mailing Address - Country:US
Mailing Address - Phone:562-799-9500
Mailing Address - Fax:562-799-9300
Practice Address - Street 1:10941 BLOOMFIELD ST
Practice Address - Street 2:SUITE A.
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2530
Practice Address - Country:US
Practice Address - Phone:562-799-9500
Practice Address - Fax:562-799-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA025668174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA87066Medicare UPIN
CAA25668Medicare ID - Type UnspecifiedMEDICARE