Individual
LAURA S BOUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
8941 N RODGERS CT SE, CALEDONIA, MI 49316-8013
(616) 252-5300
(616) 252-5390
Mailing address
5900 BYRON CENTER AVE SW, ATTN: MEDICAL ADMINISTRATION, WYOMING, MI 49519-9606
(616) 252-5300
(616) 252-5390
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
5101015239
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487617304
—
MI
Enumeration date
04/11/2006
Last updated
10/01/2018
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