Provider Demographics
NPI:1881737617
Name:PORZSOLT, LARRY ERNEST (DO)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ERNEST
Last Name:PORZSOLT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:MI
Mailing Address - Zip Code:49285-0217
Mailing Address - Country:US
Mailing Address - Phone:517-851-7255
Mailing Address - Fax:517-851-4397
Practice Address - Street 1:300 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:MI
Practice Address - Zip Code:49285-0217
Practice Address - Country:US
Practice Address - Phone:517-851-7255
Practice Address - Fax:517-851-4397
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILP005934208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1000506Medicaid
5332431Medicare ID - Type Unspecified
MI1000506Medicaid