Healthcare Provider Details

I. General information

NPI: 1447470497
Provider Name (Legal Business Name): LYNN MARIE LAITINEN KLOSS MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 E MICHIGAN AVE SUITE 101
LANSING MI
48912-2199
US

IV. Provider business mailing address

1086 BUCKINGHAM RD
HASLETT MI
48840
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-3900
  • Fax:
Mailing address:
  • Phone: 517-339-0127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number4301063588
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301063588
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: