Healthcare Provider Details

I. General information

NPI: 1528096963
Provider Name (Legal Business Name): LANSING ORTHOPEDIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 E JOLLY RD
LANSING MI
48910
US

IV. Provider business mailing address

3370 E JOLLY RD
LANSING MI
48910-8552
US

V. Phone/Fax

Practice location:
  • Phone: 517-487-3717
  • Fax: 517-492-1284
Mailing address:
  • Phone: 517-487-3717
  • Fax: 517-492-1284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLY SUE RIEVER
Title or Position: OFFICE MANAGER
Credential:
Phone: 517-364-0120