Healthcare Provider Details

I. General information

NPI: 1790803823
Provider Name (Legal Business Name): ORTHOPAEDIC SPECIALIST OF LANSING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N HOMER ST
LANSING MI
48912
US

IV. Provider business mailing address

1000 N HOMER ST
LANSING MI
48912
US

V. Phone/Fax

Practice location:
  • Phone: 517-374-7022
  • Fax: 517-374-7554
Mailing address:
  • Phone: 517-374-7022
  • Fax: 517-374-7554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number029042
License Number StateMI

VIII. Authorized Official

Name: DR. EDWARD C SLADEK
Title or Position: OWNER PHYSICIAN
Credential: MD
Phone: 517-374-7022