Provider Demographics
NPI:1699939637
Name:ANSARI, LARRY S (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:S
Last Name:ANSARI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:912 S WASHINGTON AVE
Mailing Address - Street 2:STE. 1
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-2564
Mailing Address - Country:US
Mailing Address - Phone:989-790-1001
Mailing Address - Fax:989-790-1002
Practice Address - Street 1:SPARROW HOSPITAL - TRAUMA SERVICES
Practice Address - Street 2:1215 E MICHIGAN AVE
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912
Practice Address - Country:US
Practice Address - Phone:989-790-1001
Practice Address - Fax:989-790-1002
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2018-08-15
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Provider Licenses
StateLicense IDTaxonomies
MI4301093054208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery