Provider Demographics
NPI:1003919531
Name:MICHAEL, LAURA E (DO FCAP)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:E
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:DO FCAP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ELLEN
Other - Last Name:YAGGI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11390 OLD ROSWELL ROAD SUITE 100
Mailing Address - Street 2:ENDOCHOICE PATHOLOGY
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2058
Mailing Address - Country:US
Mailing Address - Phone:678-708-4464
Mailing Address - Fax:866-240-2442
Practice Address - Street 1:11390 OLD ROSWELL ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2058
Practice Address - Country:US
Practice Address - Phone:678-708-4464
Practice Address - Fax:866-240-2442
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6874207ZP0101X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6101999OtherGHI
H00200Medicare UPIN