Provider Demographics
NPI:1962438796
Name:PRESCOTT, LAURA B (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:B
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:B
Other - Last Name:FUNKHAUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:322 W HOUGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-1264
Mailing Address - Country:US
Mailing Address - Phone:989-345-4700
Mailing Address - Fax:989-345-2991
Practice Address - Street 1:322 W HOUGHTON AVE
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-1264
Practice Address - Country:US
Practice Address - Phone:989-345-4700
Practice Address - Fax:989-345-2991
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301030939207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104829421Medicaid
MI1106593931OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI111045209OtherRR MEDICARE
MIB46089Medicare UPIN
MI0659393Medicare PIN