Healthcare Provider Details

I. General information

NPI: 1497725410
Provider Name (Legal Business Name): LUANN K LABIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 08/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 W ROYAL DR
TRAVERSE CITY MI
49684-8965
US

IV. Provider business mailing address

4020 W ROYAL DR
TRAVERSE CITY MI
49684-8965
US

V. Phone/Fax

Practice location:
  • Phone: 231-421-8099
  • Fax: 231-421-8599
Mailing address:
  • Phone: 231-421-8099
  • Fax: 231-421-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberLL093198
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: