Provider Demographics
NPI:1922078575
Name:LAREAU, ALLAN R (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:R
Last Name:LAREAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 W CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4828
Mailing Address - Country:US
Mailing Address - Phone:269-324-2400
Mailing Address - Fax:269-324-0450
Practice Address - Street 1:2680 W CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4828
Practice Address - Country:US
Practice Address - Phone:269-324-2400
Practice Address - Fax:269-324-0450
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035589208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1417961137OtherBCBSM - BMH
MI1922078575Medicaid
MI4467350Medicaid
MI3205128Medicaid
MI3205128Medicaid