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NPI Code Detail

MEDICARE: BRIAN T LAURSEN P.A.

MEDICARE: BRIAN T LAURSEN P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant10000668AIN

General Provider Information

NPI Number : 1164425187
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN T LAURSEN P.A.
Provider Business Mailing Address
First Line : PO BOX 2526
Second Line :
City : FORT WAYNE
State : IN
Zip : 46801-2526
Country : US
Telephone Number : 260-436-8686
Fax Number : 260-432-5075
Provider Business Practice Location Address
First Line : 7601 W JEFFERSON BLVD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-4133
Country : US
Telephone Number : 260-436-8686
Fax Number : 260-432-5075
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 09/19/2023

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Directions to “ BRIAN T LAURSEN P.A.” Practice Location

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