Healthcare Provider Details

I. General information

NPI: 1346447968
Provider Name (Legal Business Name): LAURA ELIZABETH CIPA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA ELIZABETH CRUMP D.O.

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HARRINGTON ST
MOUNT CLEMENS MI
48043-2920
US

IV. Provider business mailing address

1391 BEAUPRE AVE
MADISON HEIGHTS MI
48071-2683
US

V. Phone/Fax

Practice location:
  • Phone: 586-493-8195
  • Fax:
Mailing address:
  • Phone: 586-405-2969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101017323
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: