Healthcare Provider Details

I. General information

NPI: 1881737617
Provider Name (Legal Business Name): LARRY ERNEST PORZSOLT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W MAIN ST
STOCKBRIDGE MI
49285-0217
US

IV. Provider business mailing address

PO BOX 217
STOCKBRIDGE MI
49285-0217
US

V. Phone/Fax

Practice location:
  • Phone: 517-851-7255
  • Fax: 517-851-4397
Mailing address:
  • Phone: 517-851-7255
  • Fax: 517-851-4397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberLP005934
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: