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NPI Code Detail

MEDICARE: LARRY L. PACK MD

MEDICARE: LARRY L. PACK MD
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
1207X00000XOrthopaedic Surgery Physician4301035400MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477534774
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARRY L. PACK MD
Provider Business Mailing Address
First Line : PO BOX 590
Second Line :
City : GRAND BLANC
State : MI
Zip : 48480-0590
Country : US
Telephone Number : 810-750-5800
Fax Number : 810-750-5809
Provider Business Practice Location Address
First Line : 2420 OWEN RD
Second Line : STE C
City : FENTON
State : MI
Zip : 48430-3417
Country : US
Telephone Number : 810-750-5800
Fax Number : 810-750-5809
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2005
Last Update Date : 07/07/2010

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