MEDICARE: BREAST CENTER OF LANSING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1154389666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREAST CENTER OF LANSING PLLC

Provider Business Mailing Address
First Line	:	3960 PATIENT CARE WAY
Second Line	:	SUITE 109B
City	:	LANSING
State	:	MI
Zip	:	48911-4275
Country	:	US
Telephone Number	:	517-702-2940
Fax Number	:

Provider Business Practice Location Address
First Line	:	3960 PATIENT CARE WAY
Second Line	:	SUITE 109B
City	:	LANSING
State	:	MI
Zip	:	48911-4275
Country	:	US
Telephone Number	:	517-702-2940
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID R ANDERSON
Credential	:	MD
Telephone Number	:	517-702-2940

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	11/10/2008

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