Basic Information
Provider Information
NPI: 1215968169
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAURING
FirstName: ADAM
MiddleName: S.
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3621 SOUTH STATE STREET
Address2: 700 KMS PLACE
City: ANN ARBOR
State: MI
PostalCode: 48108
CountryCode: US
TelephoneNumber: 7349362047
FaxNumber:  
Practice Location
Address1: 1500 EAST MEDICAL CENTER DRIVE
Address2: 3RD FLOOR TAUBMAN CENTER RECP D
City: ANN ARBOR
State: MI
PostalCode: 481095352
CountryCode: US
TelephoneNumber: 7346475899
FaxNumber: 7346152156
Other Information
ProviderEnumerationDate: 07/06/2006
LastUpdateDate: 09/13/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XA85180CAN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RI0200X4301100406MIY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

ID Information
IDTypeStateIssuerDescription
00A85180005CA MEDICAID


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