Individual
DR. ETHELBERT M LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
205 OSCEOLA ST, LAURIUM, MI 49913-2134
(906) 225-0122
(906) 225-0135
Mailing address
710 CHIPPEWA SQ, SUITE 101, MARQUETTE, MI 49855-4821
(906) 225-0122
(906) 225-0135
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301039413
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4833513
—
MI
Enumeration date
10/24/2006
Last updated
08/11/2011
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