MEDICARE: DR. BRIAN EDWARD LAAKANIEMI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083A0100X	Aerospace Medicine Physician	0101236948	VA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207P00000X	Emergency Medicine Physician	A102322	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285619924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN EDWARD LAAKANIEMI M.D.

Provider Business Mailing Address
First Line	:	56 ROSSMORE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92620-2188
Country	:	US
Telephone Number	:	225-328-9854
Fax Number	:

Provider Business Practice Location Address
First Line	:	56 ROSSMORE
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92620-2188
Country	:	US
Telephone Number	:	225-358-3940
Fax Number	:	225-358-3939

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	04/13/2017

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