Basic Information
| Provider Information | |||||||||
| NPI: | 1366445173 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EILENDER | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | MARK | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26400 W 12 MILE RD | ||||||||
| Address2: | STE 170 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480341753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482088787 | ||||||||
| FaxNumber: | 2482088788 | ||||||||
| Practice Location | |||||||||
| Address1: | 26400 W 12 MILE RD | ||||||||
| Address2: | STE 170 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480341753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482088787 | ||||||||
| FaxNumber: | 2482088788 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 09/25/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 430040979 | MI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 2682910-10 | 05 | MI | MEDICAID |