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NPI Code Detail

MEDICARE: LARRY L PACK MD PC

MEDICARE: LARRY L PACK MD PC
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 : 1780767145
Entity Type Code : Organization
Provider Name (Legal Business Name) : LARRY L PACK MD PC
Provider Business Mailing Address
First Line : 9362 WARWICK MDWS
Second Line : PO BOX 590
City : GRAND BLANC
State : MI
Zip : 48439-9552
Country : US
Telephone Number : 810-750-5800
Fax Number :
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 : OWNER
Name : DR. LARRY L PACK
Credential : M.D.
Telephone Number : 810-750-5800
Provider Enumeration Date : 10/21/2006
Last Update Date : 04/15/2010

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