Healthcare Provider Details

I. General information

NPI: 1487920807
Provider Name (Legal Business Name): LAURA E AGRESTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 N MAPLE RD
ANN ARBOR MI
48103-2824
US

IV. Provider business mailing address

343 N MAPLE RD STE 202
ANN ARBOR MI
48103-2824
US

V. Phone/Fax

Practice location:
  • Phone: 734-475-4500
  • Fax: 734-475-4507
Mailing address:
  • Phone: 734-584-0044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301501287
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number4301501287
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: