Healthcare Provider Details

I. General information

NPI: 1184826083
Provider Name (Legal Business Name): LARISA MAY TRAILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2007
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 COLLINS RD
LANSING MI
48910-8394
US

IV. Provider business mailing address

2280 IVY HILL DR
COMMERCE TOWNSHIP MI
48382-5122
US

V. Phone/Fax

Practice location:
  • Phone: 517-975-6000
  • Fax:
Mailing address:
  • Phone: 347-426-6610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301086621
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: