Healthcare Provider Details

I. General information

NPI: 1376638429
Provider Name (Legal Business Name): LANSING INSTITUTE OF UROLOGY , P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 RAMBLEWOOD DR
EAST LANSING MI
48823-6367
US

IV. Provider business mailing address

3725 BEECH TREE LN
OKEMOS MI
48864-3871
US

V. Phone/Fax

Practice location:
  • Phone: 517-324-3700
  • Fax: 517-324-4589
Mailing address:
  • Phone: 517-349-9449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. LEONARD J ZUCKERMAN
Title or Position: CEO
Credential: M.D.
Phone: 517-324-3700