Healthcare Provider Details

I. General information

NPI: 1902063530
Provider Name (Legal Business Name): LANSING PEDIATRIC ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 LAKE LANSING RD
LANSING MI
48912-3618
US

IV. Provider business mailing address

2414 LAKE LANSING RD
LANSING MI
48912-3618
US

V. Phone/Fax

Practice location:
  • Phone: 517-371-4712
  • Fax:
Mailing address:
  • Phone: 517-371-4712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK S TAKAGISHI
Title or Position: PRESIDENT
Credential: D.O.
Phone: 517-371-4712