Healthcare Provider Details

I. General information

NPI: 1790886372
Provider Name (Legal Business Name): LAKE LANSING ASC PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 LAKE LANSING RD
LANSING MI
48912-3742
US

IV. Provider business mailing address

1707 LAKE LANSING RD
LANSING MI
48912-3742
US

V. Phone/Fax

Practice location:
  • Phone: 517-708-3333
  • Fax: 517-267-0430
Mailing address:
  • Phone: 517-708-3333
  • Fax: 517-267-0430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number336816
License Number StateMI

VIII. Authorized Official

Name: JENNIFER MCDONALD
Title or Position: BUSINESS MANAGER
Credential:
Phone: 517-252-8698