Healthcare Provider Details

I. General information

NPI: 1699939637
Provider Name (Legal Business Name): LARRY S ANSARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 08/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SPARROW HOSPITAL - TRAUMA SERVICES 1215 E MICHIGAN AVE
LANSING MI
48912
US

IV. Provider business mailing address

912 S WASHINGTON AVE STE. 1
SAGINAW MI
48601-2564
US

V. Phone/Fax

Practice location:
  • Phone: 989-790-1001
  • Fax: 989-790-1002
Mailing address:
  • Phone: 989-790-1001
  • Fax: 989-790-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301093054
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: