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NPI Code Detail

MEDICARE: LANSING INSTITUTE OF BEHAVIORAL MEDICINE, PLLC

MEDICARE: LANSING INSTITUTE OF BEHAVIORAL MEDICINE, 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
12084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1386954907
Entity Type Code : Organization
Provider Name (Legal Business Name) : LANSING INSTITUTE OF BEHAVIORAL MEDICINE, PLLC
Provider Business Mailing Address
First Line : 3475 BELLE CHASE WAY
Second Line :
City : LANSING
State : MI
Zip : 48911-4252
Country : US
Telephone Number : 517-882-3732
Fax Number : 517-882-3633
Provider Business Practice Location Address
First Line : 3475 BELLE CHASE WAY
Second Line :
City : LANSING
State : MI
Zip : 48911-4252
Country : US
Telephone Number : 517-882-3732
Fax Number : 517-882-3633
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : KRISTINA DORRENE CONRAD
Credential :
Telephone Number : 517-882-3732
Provider Enumeration Date : 10/16/2010
Last Update Date : 12/09/2021

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