Provider Demographics
NPI:1174354807
Name:LARA, MICHAEL A I
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:LARA
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9581 KICKAPOO PASS
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-5309
Mailing Address - Country:US
Mailing Address - Phone:330-472-3731
Mailing Address - Fax:
Practice Address - Street 1:9581 KICKAPOO PASS
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5309
Practice Address - Country:US
Practice Address - Phone:330-472-3731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)