Provider Demographics
NPI:1265517452
Name:LACLAIR, PAUL ALLEN (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ALLEN
Last Name:LACLAIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 TOWNE CENTRE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2841
Mailing Address - Country:US
Mailing Address - Phone:989-498-5100
Mailing Address - Fax:989-498-5122
Practice Address - Street 1:4901 TOWNE CENTRE RD
Practice Address - Street 2:STE 300
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2841
Practice Address - Country:US
Practice Address - Phone:989-498-5100
Practice Address - Fax:989-498-5122
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301072856208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
2507311471OtherBCBSM
0993973OtherHEALTHPLUS
MI4936673Medicaid
G24813Medicare UPIN
MIP18300001Medicare PIN