Individual
LAUREN SURROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
154 S MAIN ST STE 6, FRANKENMUTH, MI 48734-1692
(989) 502-1122
(989) 502-1212
Mailing address
154 S MAIN ST STE 6, FRANKENMUTH, MI 48734-1692
(989) 502-1122
(989) 502-1212
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601006225
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0M32030
MEDICARE PTAN
MI
01
—
1033493309
NPI
—
05
—
1033493309
—
MI
01
—
1225547383
TYPE 2 NPI
—
01
—
M23560368
MEDICARE
—
Enumeration date
10/05/2011
Last updated
08/18/2021
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