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Organization

PAI PARTICIPANT 23 SC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ERIN LAIRD (AUTHORIZED OFFICIAL)
(410) 458-8713
Entity
Organization

Contact information

Practice address
1475 BIRCH HILL LN, SHAWANO, WI 54166-3707
(715) 526-3161
Mailing address
PO BOX 639676, CINCINNATI, OH 45263-9676
(859) 291-4800
(859) 655-8588

Taxonomy

Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary

Other

Enumeration date
09/22/2020
Last updated
09/22/2020
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