Provider Demographics
NPI:1811008741
Name:LAUX, MATTHEW J (PAC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:LAUX
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-1050
Mailing Address - Country:US
Mailing Address - Phone:734-763-6924
Mailing Address - Fax:734-647-3071
Practice Address - Street 1:207 FLETCHER
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-1050
Practice Address - Country:US
Practice Address - Phone:734-763-6924
Practice Address - Fax:734-647-3071
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001404363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION55630002Medicare ID - Type Unspecified
R66759Medicare UPIN