MEDICARE: MICHAEL HENRY LAURET M.D.

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
1	208000000X	Pediatrics Physician	185001-1205	UT

General Provider Information

NPI Number	:	1821056029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL HENRY LAURET M.D.

Provider Business Mailing Address
First Line	:	1355 N UNIVERSITY AVE
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-2721
Country	:	US
Telephone Number	:	801-373-8930
Fax Number	:	801-377-6811

Provider Business Practice Location Address
First Line	:	1355 N UNIVERSITY AVE
Second Line	:	#210
City	:	PROVO
State	:	UT
Zip	:	84604-2721
Country	:	US
Telephone Number	:	801-373-8930
Fax Number	:	801-377-6811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	08/10/2011

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