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General NPI Number Information
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NPI Number | 1811041890
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Entity Type | Organization
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Legal Business Name | LENISE A. BANSE, M.D.,P.C.
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 06/25/2010
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Provider Practice Location Address
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Address Line | 42452 HAYES RD SUITE 3
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-6771
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Country | US
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Telephone | 586-263-3130
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Fax | 586-263-5183
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Provider Business Mailing Address
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Address Line | 42452 HAYES RD SUITE 3
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-6771
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Country | US
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Telephone | 586-263-3130
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Fax | 586-263-5183
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Authorized Official
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Title or Position | OWNER
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Name | DR. LENISE BANSE
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Credential | M.D.
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Telephone | 586-263-3130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number | 4301047653
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 4301047653
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 4301047653
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License Number State | MI
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