Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 5101021354 | MI |
NPI | 1013322528 |
---|---|
Provider Name | Laura Tate |
First Address | Lansing, MI 48912-1811 |
Second Address | Lansing, MI 48912-1811 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2014 |
Last Update Date | 23/06/2014 |