Healthcare Provider Details

I. General information

NPI: 1265579734
Provider Name (Legal Business Name): MCLAREN GREATER LANSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 11/14/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 DISCOVERY DR STE 200
LANSING MI
48910-8609
US

IV. Provider business mailing address

PO BOX 775429
CHICAGO IL
60677-5429
US

V. Phone/Fax

Practice location:
  • Phone: 517-975-8910
  • Fax: 517-975-8925
Mailing address:
  • Phone: 517-975-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number5101012213
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DALE THOMPSON
Title or Position: CFO
Credential:
Phone: 517-975-7555