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General NPI Number Information
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NPI Number | 1649690181
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Entity Type | Individual
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Provider Name | ELIZABETH ROSE LARSEN MD
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Gender | Female
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Dates
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Enumeration Date | 04/23/2014
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 4235 SECOR RD
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City | TOLEDO
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State | OH
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Zip | 43623-4231
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Country | US
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Telephone | 419-473-3561
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Fax |
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Provider Business Mailing Address
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Address Line | 1735 HOLLAND ST
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City | BIRMINGHAM
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State | MI
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Zip | 48009-7804
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Country | US
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Telephone | 612-232-9049
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036146507
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 35.151726
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 4301507572
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License Number State | MI
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