Healthcare Provider Details

I. General information

NPI: 1285718064
Provider Name (Legal Business Name): MCLAREN GREATER LANSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W GREENLAWN AVE SUITE 305
LANSING MI
48910-2898
US

IV. Provider business mailing address

405 W GREENLAWN AVE SUITE 305
LANSING MI
48910-2898
US

V. Phone/Fax

Practice location:
  • Phone: 517-483-4780
  • Fax: 517-483-7595
Mailing address:
  • Phone: 517-483-4780
  • Fax: 517-483-7595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN LANCIOTTI
Title or Position: CFO
Credential:
Phone: 517-975-7555