Healthcare Provider Details

I. General information

NPI: 1518497270
Provider Name (Legal Business Name): LAURA BETH JAMROG DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 S LINDEN RD
FLINT MI
48532-3442
US

IV. Provider business mailing address

1303 S LINDEN RD STE D
FLINT MI
48532-3442
US

V. Phone/Fax

Practice location:
  • Phone: 810-230-0177
  • Fax: 810-230-8090
Mailing address:
  • Phone: 810-230-0177
  • Fax: 810-230-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002675
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: