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General NPI Number Information
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NPI Number | 1376765891
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Entity Type | Individual
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Provider Name | TODD A LANSER MD
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 04/15/2016
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Provider Practice Location Address
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Address Line | 180 S MAIN ST
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City | CANTON
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State | IL
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Zip | 61520-2608
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Country | US
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Telephone | 309-647-0201
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Fax | 309-649-6880
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Provider Business Mailing Address
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Address Line | 180 S MAIN ST
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City | CANTON
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State | IL
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Zip | 61520-2608
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Country | US
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Telephone | 309-647-0201
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Fax | 309-649-5101
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036-121825
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License Number State | IL
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