Provider Demographics
NPI:1639174212
Name:LAURINAITIS, MARIUS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIUS
Middle Name:
Last Name:LAURINAITIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIUS
Other - Middle Name:
Other - Last Name:LAURINAITIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 45443
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84145-0443
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:820 PRUDENTIAL DR STE 304
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8205
Practice Address - Country:US
Practice Address - Phone:904-202-3860
Practice Address - Fax:904-202-3846
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071796207R00000X, 208M00000X
FLME118114208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1639174212OtherNPI #
MI4846413Medicaid
MI70-0-F32947-0OtherBCBS CPIN #
MIML071796OtherBCBSM
MIP28070007Medicare PIN
H37172Medicare UPIN