Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4301063943 | MI |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 4301063943 | MI |
NPI | 1437130713 |
---|---|
Provider Name | Susan Marie Mosier-Laclair |
First Address | Flint, MI 48507-3170 |
Second Address | Flint, MI 48507-3170 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 19/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0B51156 | GROUP BCBS (01) | MI |
0N45090 | GROUP MEDICARE (01) | |
1215930490 | TYPE 2 NPI (01) | |
4190763 | (05) | MI |
CB0923 | GROUP RAILROAD (01) | |
H15018 | (02) |