Individual
LARRY L. PACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2420 OWEN RD, STE C, FENTON, MI 48430-3417
(810) 750-5800
(810) 750-5809
Mailing address
PO BOX 590, GRAND BLANC, MI 48480-0590
(810) 750-5800
(810) 750-5809
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
4301035400
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4940460
—
MI
Enumeration date
11/14/2005
Last updated
07/07/2010
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