Organization
LAURIE S BRAKER MD PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURIE BRAKER MD (OWNER)
(616) 374-7660
Entity
Organization
Contact information
Practice address
4294 LAUREL DR, LAKE ODESSA, MI 48849-8430
(616) 374-7660
(616) 374-0270
Mailing address
4294 LAUREL DR, PO BOX 578, LAKE ODESSA, MI 48849-8430
(616) 374-7660
(616) 374-0270
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301080130
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4765084
—
MI
Enumeration date
03/21/2011
Last updated
03/21/2011
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