Healthcare Provider Details

I. General information

NPI: 1003929845
Provider Name (Legal Business Name): BARRY L LAUGHLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 HASLETT RD
HASLETT MI
48840
US

IV. Provider business mailing address

1623 HASLETT RD
HASLETT MI
48840
US

V. Phone/Fax

Practice location:
  • Phone: 517-339-2100
  • Fax: 517-339-4620
Mailing address:
  • Phone: 517-339-2100
  • Fax: 517-339-4620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301046678
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: