Basic Information
| Provider Information | |||||||||
| NPI: | 1447742721 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LA PORTE | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | SHARON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7394 BRIARGATE DR | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481871410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347889540 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 30000 HIVELEY ST | ||||||||
| Address2: | |||||||||
| City: | INKSTER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481411089 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347283400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2018 | ||||||||
| LastUpdateDate: | 06/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.