Basic Information
| Provider Information | |||||||||
| NPI: | 1265517452 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LACLAIR | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4901 TOWNE CENTRE RD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486042841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894985100 | ||||||||
| FaxNumber: | 9894985122 | ||||||||
| Practice Location | |||||||||
| Address1: | 4901 TOWNE CENTRE RD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486042841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894985100 | ||||||||
| FaxNumber: | 9894985122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 09/16/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 4301072856 | MI | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 2507311471 | 01 | BCBSM | OTHER | 0993973 | 01 | HEALTHPLUS | OTHER | 4936673 | 05 | MI | MEDICAID |