Provider Demographics
NPI:1144791732
Name:LAIRD AND LAIRD SURGICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:LAIRD AND LAIRD SURGICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTEN
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:LAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-307-3040
Mailing Address - Street 1:1405 13TH ST
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-3335
Mailing Address - Country:US
Mailing Address - Phone:734-307-3040
Mailing Address - Fax:
Practice Address - Street 1:2128 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-5470
Practice Address - Country:US
Practice Address - Phone:734-307-3040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-08
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty