Healthcare Provider Details

I. General information

NPI: 1720227739
Provider Name (Legal Business Name): DR. WESLEY C. LOCKHART, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3394 E JOLLY RD SUITE D
LANSING MI
48910-8594
US

IV. Provider business mailing address

PO BOX 1207
EAST LANSING MI
48826-1207
US

V. Phone/Fax

Practice location:
  • Phone: 517-203-0183
  • Fax:
Mailing address:
  • Phone: 517-203-0183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number5101012587
License Number StateMI

VIII. Authorized Official

Name: DR. WESLEY C LOCKHART
Title or Position: PRESIDENT/CEO
Credential: DO
Phone: 517-203-0183