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General NPI Number Information
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NPI Number | 1417905613
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Entity Type | Organization
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Legal Business Name | GREATER LANSING SURGEONS, P.C.
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 2815 S PENNSYLVANIA AVE SUITE 105
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City | LANSING
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State | MI
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Zip | 48910-3496
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Country | US
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Telephone | 517-487-8255
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Fax | 517-487-2059
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Provider Business Mailing Address
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Address Line | 2815 S PENNSYLVANIA AVE SUITE 105
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City | LANSING
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State | MI
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Zip | 48910-3496
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Country | US
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Telephone | 517-487-8255
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Fax | 517-487-2059
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES WILLIAM MERCER
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Credential | D.O.
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Telephone | 517-487-8255
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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 | SS013541
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | JD014681
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | CM005070
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License Number State | MI
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