Individual
MISS LAURA DOROTHY KONSITZKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
22201 MOROSS RD STE 380, DETROIT, MI 48236-2176
(877) 784-3667
(313) 343-4567
Mailing address
38136 KLARR DR, NORTHVILLE, MI 48167-9036
(248) 880-8638
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601009074
MI
Other
Enumeration date
06/10/2019
Last updated
06/10/2019
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