Provider Demographics
NPI:1053995522
Name:LENZ, BROOKE M (DO)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:M
Last Name:LENZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:RIEMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3200 EAGLE PARK DR NE STE 102
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-7057
Mailing Address - Country:US
Mailing Address - Phone:616-285-9090
Mailing Address - Fax:616-285-7947
Practice Address - Street 1:3200 EAGLE PARK DR NE STE 102
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7057
Practice Address - Country:US
Practice Address - Phone:616-285-9090
Practice Address - Fax:616-285-7947
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151015007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine