LARRY L PACK MD PC (NPI# 1780767145) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780767145 |
| Entity Type | Organization |
| Organization Name | LARRY L PACK MD PC |
| Practice Address |
2420 Owen Rd Ste C Fenton MI 48430-3417 |
| Mailing Address |
9362 Warwick Mdws Po Box 590 Grand Blanc MI 48439-9552 |
| Practice Telephone | 8107505800 |
| Practice Fax Number | 8107505809 |
| Mailing Telephone | 8107505800 |
| Enumeration Date | 2006-10-21 |
| Last Update Date | 2010-04-15 |
| Authorized Official Name | DR. LARRY L PACK (OWNER) |
| Authorized Official Telephone | 8107505800 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | 4301035400 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 4940460 | 05 |
| Street Address |
2420 OWEN RD STE C |
| City | FENTON |
| State | MI |
| Zip Code | 48430-3417 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821088162 | Soon A Choi | Internal Medicine | 2420 Owen Rd, Fenton, MI 48430-3417 | 2005-10-27 |
| 1619258571 | Dale M Williams | Pharmacist | 2420 Owen Rd, Fenton, MI 48430-3417 | 2011-09-06 |
| 1255568523 | Shelly Marie Oles | Nurse Practitioner | 2420 Owen Rd, Fenton, MI 48430-3417 | 2009-06-15 |
| 1639351497 | Brian Andrew Michalkow | Dentist | 2420 Owen Rd, Suite E, Fenton, MI 48430-3417 | 2007-12-03 |
| 1164614798 | Mclaren Medical Group | Emergency Medicine | 2420 Owen Rd, Fenton, MI 48430-3417 | 2007-08-17 |
| 1992887046 | David George Drake | Dentist | 2420 Owen Rd, Fenton, MI 48430-3417 | 2006-10-19 |
| 1043309933 | Shaheen K Mohammed | Internal Medicine | 2420 Owen Rd, Fenton, MI 48430-3417 | 2006-10-11 |
| 1538173752 | Steven Nick Glavas | Family Medicine | 2420 Owen Rd, Fenton, MI 48430-3417 | 2006-07-27 |
| 1548230527 | David F Schwarz | Family Medicine | 2420 Owen Rd, Fenton, MI 48430-3417 | 2006-01-24 |
| 1477534774 | Larry L. Pack | Orthopaedic Surgery | 2420 Owen Rd, Ste C, Fenton, MI 48430-3417 | 2005-11-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225647514 | Drs Mesh, P.C. | Dentist | 15555 Silver Parkway, Fenton, MI 48430 | 2020-07-23 |
| 1225515091 | Erica Anderson | Social Worker | 127 River St., Fenton, MI 48430 | 2018-07-25 |
| 1245767888 | Optimum Balance | Clinic/Center | 1537 N. Leroy Street, Suite D, Fenton, MI 48430 | 2017-05-14 |
| 1710411293 | Abdul Hassan | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 11 Chateaux Du Lac, Fenton, MI 48430 | 2017-04-12 |
| 1366994410 | Intentional Wellbeing LLC | Psychologist | 1122 N. Leroy Rd, Suite A, Fenton, MI 48430 | 2016-10-25 |
| 1265801625 | Shawn Marie Gorkiewicz | Nurse Practitioner | 435 North Leroy, Fenton, MI 48430 | 2015-09-16 |
| 1972994226 | Carrie Hamilton | Physical Medicine & Rehabilitation | 102 N Adelaide St Ste B, Fenton, MI 48430 | 2015-02-09 |
| 1104222520 | Wellbridge of Fenton, LLC | Skilled Nursing Facility | 901 Pine Creek Drive, Fenton, MI 48430 | 2014-11-12 |
| 1225442759 | Joseph Matthew Leppek | Optometrist | 1425 N. Leroy St., Fenton, MI 48430 | 2014-06-12 |
| 1437569647 | Therapy Support Center LLC | Clinic/Center | 113 North River Street, Fenton, MI 48430 | 2014-04-28 |
| Find all providers in zip 48430 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578086146 | Edward J. Lis, Jr, Do, Pllc | Orthopaedic Surgery | 17200 Silver Pkwy, Fenton, MI 48430-4437 | 2017-07-25 |
| 1124579966 | Ssm Medical Group Inc. | Orthopaedic Surgery | 1011 Bowles Ave, Suite 400, Fenton, MO 63026-2395 | 2016-10-17 |
| 1053644872 | Lawrence G Evans Md LLC | Orthopaedic Surgery | 1011 Bowles Ave, Suite 400, Fenton, MO 63026-2395 | 2009-09-11 |
| 1003079344 | Michigan Center for Orthopedic Surgery Plc | Orthopaedic Surgery | 17200 Silver Pkwy, Fenton, MI 48430-3423 | 2008-07-08 |
| 1225006265 | Kurt D Merkel | Orthopaedic Surgery | 1011 Bowles Ave, Suite 400, Fenton, MO 63026-2395 | 2006-03-08 |
| 1891766754 | Clayton R Perry, Md PC | Orthopaedic Surgery | 1011 Bowles Ave, Suite 400, Fenton, MO 63026-2387 | 2006-01-30 |
| 1518938463 | Clayton R Perry | Orthopaedic Surgery | 1011 Bowles Ave, Suite 400, Fenton, MO 63026-2395 | 2006-01-30 |
| 1568433639 | Peter J Anderson, Md PC | Orthopaedic Surgery | 1011 Bowles Ave, Suite 400, Fenton, MO 63026-2387 | 2006-01-27 |
| 1477534774 | Larry L. Pack | Orthopaedic Surgery | 2420 Owen Rd, Ste C, Fenton, MI 48430-3417 | 2005-11-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740805365 | Conner D Ahlgren | Orthopaedic Surgery | 3535 W 13 Mile Rd Ste 742, Royal Oak, MI 48073-6770 | 2020-06-09 |
| 1063035319 | Alex Kane Miller | Orthopaedic Surgery | 3577 W 13 Mile Rd Ste 402, Royal Oak, MI 48073-6710 | 2020-05-21 |
| 1396374716 | Arjun Patel | Orthopaedic Surgery | Ascension Genesys, Gme Dept, One Genesys Pkwy, Grand Blanc, MI 48439-4843 | 2020-04-07 |
| 1346876711 | Timothy Curtis Mead | Orthopaedic Surgery | 4752 Lake Harbor Rd, Norton Shores, MI 49441-5236 | 2020-03-18 |
| 1932751112 | Mendelson Warren Pharmacy | Orthopaedic Surgery | 11900 E 12 Mile Rd Ste 105, Warren, MI 48093-3487 | 2019-07-09 |
| 1023678059 | Th Mg Ohio LLC | Orthopaedic Surgery | 1050 Wilshire Dr Ste 300, Troy, MI 48084-1526 | 2019-06-20 |
| 1609430321 | Mohamed Saad-waterworks, PC | Orthopaedic Surgery | 21031 Michigan Ave Fl 2, Dearborn, MI 48124-2339 | 2019-04-29 |
| 1346804135 | Matthew M Astolfi | Orthopaedic Surgery | 3601 W Thirteenth Mile Road, Royal Oak, MI 48073 | 2019-04-26 |
| 1588228845 | Muhammad Talha Padela | Orthopaedic Surgery | 3990 John R St Ste 7b, Detroit, MI 48201 | 2019-04-23 |
| 1134681125 | Neuro Spine Institute Pllc | Orthopaedic Surgery | 29255 Northwestern Hwy Ste 202, Southfield, MI 48034-5741 | 2019-04-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.