Provider Demographics
NPI:1437393378
Name:ANDERSON, LAURA MARIE (MD (AS OF 6/2009))
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD (AS OF 6/2009)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4239 COMMONWEALTH ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-2910
Mailing Address - Country:US
Mailing Address - Phone:313-575-0764
Mailing Address - Fax:
Practice Address - Street 1:2500 METROHEALTH DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1900
Practice Address - Country:US
Practice Address - Phone:216-778-2882
Practice Address - Fax:216-778-1384
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program