Provider Demographics
NPI:1396234829
Name:PARKS, LAURA (DO)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:PARKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HARBOR BEACH
Mailing Address - State:MI
Mailing Address - Zip Code:48441-1236
Mailing Address - Country:US
Mailing Address - Phone:989-479-3291
Mailing Address - Fax:989-479-3365
Practice Address - Street 1:230 S 1ST ST
Practice Address - Street 2:
Practice Address - City:HARBOR BEACH
Practice Address - State:MI
Practice Address - Zip Code:48441-1236
Practice Address - Country:US
Practice Address - Phone:989-479-3291
Practice Address - Fax:989-479-3365
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151012560207Q00000X
MI5101023805207Q00000X
MI5101025495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty