Provider Demographics
NPI:1740552249
Name:LARSEN, BRETT ERIK (MD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ERIK
Last Name:LARSEN
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 1:302 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2044
Mailing Address - Country:US
Mailing Address - Phone:810-762-8092
Mailing Address - Fax:810-762-8892
Practice Address - Street 1:3500 CALKINS RD STE A
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3500
Practice Address - Country:US
Practice Address - Phone:810-515-7662
Practice Address - Fax:810-337-1479
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4301111208208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program