Healthcare Provider Details

I. General information

NPI: 1417303108
Provider Name (Legal Business Name): LAUREN BRANDY KWASNY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE STE 655
LANSING MI
48912-1837
US

IV. Provider business mailing address

1200 E MICHIGAN AVE STE 655
LANSING MI
48912-1837
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5388
  • Fax:
Mailing address:
  • Phone: 517-364-5388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101026271
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: