Healthcare Provider Details

I. General information

NPI: 1477472272
Provider Name (Legal Business Name): LANA WIRGAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42590 STEPNITZ DR
CLINTON TOWNSHIP MI
48036-3161
US

IV. Provider business mailing address

36330 TARPON DR
STERLING HEIGHTS MI
48312-3074
US

V. Phone/Fax

Practice location:
  • Phone: 586-954-1838
  • Fax:
Mailing address:
  • Phone: 586-707-7214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: