Healthcare Provider Details

I. General information

NPI: 1740280965
Provider Name (Legal Business Name): SUSAN LANSER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 04/17/2022
Certification Date: 04/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ROLAND ST
MC BAIN MI
49657-9683
US

IV. Provider business mailing address

100 N ROLAND ST
MC BAIN MI
49657-9683
US

V. Phone/Fax

Practice location:
  • Phone: 231-876-4600
  • Fax: 231-392-7311
Mailing address:
  • Phone: 231-876-4600
  • Fax: 231-392-7311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301073155
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: