Healthcare Provider Details

I. General information

NPI: 1750770913
Provider Name (Legal Business Name): MICHAEL LANNING RD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MITCHELL AVE
BATESVILLE IN
47006-8909
US

IV. Provider business mailing address

PO BOX 226 321 MITCHELL AVE
BATESVILLE IN
47006-0226
US

V. Phone/Fax

Practice location:
  • Phone: 812-933-5122
  • Fax: 812-933-5252
Mailing address:
  • Phone: 812-933-5122
  • Fax: 812-933-5252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86027260
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: