Basic Information
| Provider Information | |||||||||
| NPI: | 1780983171 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCNEW | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | KOLLAR | ||||||||
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| Credential: | M.D. | ||||||||
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| OtherLastName: | KOLLAR | ||||||||
| OtherFirstName: | LAURA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3621 S STATE ST | ||||||||
| Address2: | 700 KMS PLACE | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349362047 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 22301 FOSTER WINTER DR | ||||||||
| Address2: | FLOOR 1 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480753713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488493321 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2011 | ||||||||
| LastUpdateDate: | 03/29/2016 | ||||||||
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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 | 2085R0001X | ML60287716 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 4301098702 | MI | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.