Healthcare Provider Details

I. General information

NPI: 1851646319
Provider Name (Legal Business Name): NINA MARIE LAUDATO M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2012
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BEAUBIEN ST
DETROIT MI
48201-2119
US

IV. Provider business mailing address

2445 TORQUAY AVE APT 203
ROYAL OAK MI
48073-1134
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5437
  • Fax:
Mailing address:
  • Phone: 561-289-0280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301101246
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberS0494
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: