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General NPI Number Information
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NPI Number | 1376728642
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Entity Type | Organization
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Legal Business Name | LANSING HERNIA CENTER PC
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 901 E MOUNT HOPE AVE
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City | LANSING
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State | MI
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Zip | 48910-3207
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Country | US
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Telephone | 517-372-9880
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Fax | 517-372-9882
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Provider Business Mailing Address
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Address Line | 901 E MOUNT HOPE AVE
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City | LANSING
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State | MI
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Zip | 48910-3207
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Country | US
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Telephone | 517-372-9880
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Fax | 517-372-9882
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES E. MCGILLICUDDY
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Credential | M.D.
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Telephone | 517-372-9880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | JM026995
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License Number State | MI
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