Provider Demographics
NPI:1124054341
Name:BARANCIN, LISA K (PA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:BARANCIN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 67000
Mailing Address - Street 2:DEPT 272801
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48267-2728
Mailing Address - Country:US
Mailing Address - Phone:517-841-7490
Mailing Address - Fax:517-841-6913
Practice Address - Street 1:8958 M 50
Practice Address - Street 2:
Practice Address - City:ONSTED
Practice Address - State:MI
Practice Address - Zip Code:49265-9461
Practice Address - Country:US
Practice Address - Phone:517-467-4424
Practice Address - Fax:517-467-2226
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-06-01
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Provider Licenses
StateLicense IDTaxonomies
MI5601004295363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q22733Medicare UPIN