Healthcare Provider Details

I. General information

NPI: 1265600902
Provider Name (Legal Business Name): MCLAREN GREATER LANSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 LAKE LANSING RD SUITE O
LANSING MI
48912
US

IV. Provider business mailing address

1515 LAKE LANSING RD SUITE O
LANSING MI
48912-3753
US

V. Phone/Fax

Practice location:
  • Phone: 517-372-9967
  • Fax: 517-372-0669
Mailing address:
  • Phone: 517-372-9967
  • Fax: 517-372-0669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

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