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Individual
MRS. THERESA LARSEN
Active
Individual
MRS. THERESA LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301407146
MI
208000000X
Pediatrics Physician
4301407146
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3053240
—
MI
Enumeration date
07/07/2005
Last updated
10/03/2013
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