Laurie S Braker MD PLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301080130 Issued in MI

Legal business name

LAURIE S BRAKER MD PLC

Practice address

4294 Laurel Dr
Lake Odessa, MI 48849-8430

Phone

(616) 374-7660

Fax

(616) 374-0270

NPI assigned

Mar 21, 2011

Last updated

Mar 21, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Laurie Braker, MDNPI 1073624573

Title

Owner

Phone

(616) 374-7660

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Laurie S Braker, MD

  • Family Medicine Physician
  • Lake Odessa, MI
  • NPI 1073624573
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300665600000",
    "number": "1942509666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4294 LAUREL DR",
            "address_2": "PO BOX 578",
            "city": "LAKE ODESSA",
            "state": "MI",
            "postal_code": "488498430",
            "telephone_number": "616-374-7660",
            "fax_number": "616-374-0270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4294 LAUREL DR",
            "city": "LAKE ODESSA",
            "state": "MI",
            "postal_code": "488498430",
            "telephone_number": "616-374-7660",
            "fax_number": "616-374-0270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAURIE S BRAKER MD PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-21",
        "last_updated": "2011-03-21",
        "status": "A",
        "authorized_official_last_name": "BRAKER",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-374-7660",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301080130",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4765084",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linda L. Kimmel, MA, LPC
• Kathryn Kutas
• Lake Odessa Dental, PLLC (Lake Odessa Dental Associates)
• Lake Odessa Pharmacy (Lake O Rx)
• Lansing Ophthalmology, PC (LO Eye Care)
• Gerald T Licari, DDS
• Lo Optical, LLC
• Luminate Home Care, LLC
• Moran Diagnostic Services, LLC (Physicians Mobile Imaging)
• Lisa Neeb, LPN

• Family Medicine Physician in Lake Odessa, MI
• Providers in Lake Odessa, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.