Healthcare Provider Details

I. General information

NPI: 1619058757
Provider Name (Legal Business Name): LANSING RHEUMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 PINE HOLLOW DR SUITE 400
EAST LANSING MI
48823-9700
US

IV. Provider business mailing address

PO BOX 259
EAST LANSING MI
48826-0259
US

V. Phone/Fax

Practice location:
  • Phone: 517-339-1676
  • Fax: 517-339-2716
Mailing address:
  • Phone: 517-339-1676
  • Fax: 517-339-2716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number4301055581
License Number StateMI

VIII. Authorized Official

Name: DR. NITI THAKUR
Title or Position: PRESIDENT
Credential: MD
Phone: 517-339-1676