Healthcare Provider Details

I. General information

NPI: 1245513951
Provider Name (Legal Business Name): LAURA M BREIDINGER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 W CARO RD
CARO MI
48723-9686
US

IV. Provider business mailing address

1003 WOODSIDE AVE
ESSEXVILLE MI
48732-1234
US

V. Phone/Fax

Practice location:
  • Phone: 989-672-2100
  • Fax: 989-672-6014
Mailing address:
  • Phone: 989-892-7722
  • Fax: 989-892-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601006184
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: