Healthcare Provider Details

I. General information

NPI: 1003724790
Provider Name (Legal Business Name): LARA KAWSAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 E MICHIGAN AVE
SALINE MI
48176-1547
US

IV. Provider business mailing address

5069 KENILWORTH ST
DEARBORN MI
48126-3159
US

V. Phone/Fax

Practice location:
  • Phone: 734-429-4991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number5351019309
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: