Healthcare Provider Details

I. General information

NPI: 1265517452
Provider Name (Legal Business Name): PAUL ALLEN LACLAIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 TOWNE CENTRE RD STE 300
SAGINAW MI
48604-2841
US

IV. Provider business mailing address

4901 TOWNE CENTRE RD STE 300
SAGINAW MI
48604-2841
US

V. Phone/Fax

Practice location:
  • Phone: 989-498-5100
  • Fax: 989-498-5122
Mailing address:
  • Phone: 989-498-5100
  • Fax: 989-498-5122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4301072856
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: