Basic Information
| Provider Information | |||||||||
| NPI: | 1942640461 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCLAURY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 S 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571050900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053362140 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1035 S HIGHLINE PL | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571101000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053222945 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2013 | ||||||||
| LastUpdateDate: | 11/16/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 53405 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 0872 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.