Healthcare Provider Details

I. General information

NPI: 1154288496
Provider Name (Legal Business Name): ERIC LARDIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1426 E MICHIGAN AVE
LANSING MI
48912-2107
US

IV. Provider business mailing address

1426 E MICHIGAN AVE
LANSING MI
48912-2107
US

V. Phone/Fax

Practice location:
  • Phone: 586-295-3001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704403895
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: