MEDICARE: LAKE LANSING FAMILY PRACTICE, 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1639430325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE LANSING FAMILY PRACTICE, PLLC

Provider Business Mailing Address
First Line	:	1568 LAKE LANSING RD
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48912-3707
Country	:	US
Telephone Number	:	517-913-3980
Fax Number	:	517-913-3981

Provider Business Practice Location Address
First Line	:	1568 LAKE LANSING RD
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48912-3707
Country	:	US
Telephone Number	:	517-913-3980
Fax Number	:	517-913-3981

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	ARTHUR JAMES RONAN
Credential	:	DO
Telephone Number	:	517-913-3980

Provider Enumeration Date	:	05/30/2012
Last Update Date	:	10/16/2015

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