Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 1167 | ME |
Y | 111NI0900X | Internist | 1167 | ME |
N | 207RI0200X | Infectious Disease | 1167 | ME |
NPI | 1073579074 |
---|---|
Provider Name | Laureen A Biczak |
First Address | South Portland, ME 04106-5900 |
Second Address | South Portland, ME 04106-1718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 13/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
018025 | ANTHEM (01) | |
1041404 | AETNA (01) | |
265860099 | (05) | ME |
E61016 | (02) |