Individual
LAURIE J DAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
245 STATE ST SE, GRAND RAPIDS, MI 49503-4348
(616) 685-8500
(616) 685-8075
Mailing address
245 STATE ST SE, GRAND RAPIDS, MI 49503-4328
(616) 685-1808
(616) 685-1850
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301053702
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3211260
—
MI
05
—
3415582
—
MI
05
—
4202560
—
MI
05
—
4349561
—
MI
05
—
4349570
—
MI
05
—
4349580
—
MI
05
—
4380884
—
MI
05
—
4382109
—
MI
05
—
4878471
—
MI
Enumeration date
05/15/2006
Last updated
12/17/2021
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