Provider Demographics
NPI:1376993535
Name:MICO, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42018 UTAH DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-2964
Mailing Address - Country:US
Mailing Address - Phone:586-850-5235
Mailing Address - Fax:
Practice Address - Street 1:42018 UTAH DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-2964
Practice Address - Country:US
Practice Address - Phone:586-850-5235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other