Healthcare Provider Details

I. General information

NPI: 1336491232
Provider Name (Legal Business Name): MCLAREN GREATER LANSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2134 HAMPTON PL
OKEMOS MI
48864
US

IV. Provider business mailing address

2134 HAMPTON PL
OKEMOS MI
48864-3691
US

V. Phone/Fax

Practice location:
  • Phone: 517-347-3000
  • Fax: 517-347-8393
Mailing address:
  • Phone: 517-347-3000
  • Fax: 517-347-8393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. DALE THOMPSON
Title or Position: CFO
Credential:
Phone: 517-975-7555