Healthcare Provider Details

I. General information

NPI: 1275574592
Provider Name (Legal Business Name): MARK E LANSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 E RACINE ST
JANESVILLE WI
53546-2343
US

IV. Provider business mailing address

3200 E RACINE ST
JANESVILLE WI
53546-2343
US

V. Phone/Fax

Practice location:
  • Phone: 608-371-8000
  • Fax: 608-371-8943
Mailing address:
  • Phone: 608-371-8000
  • Fax: 608-371-8943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number31143-020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number31143-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: