Provider Demographics
NPI:1285718064
Name:MCLAREN GREATER LANSING
Entity type:Organization
Organization Name:MCLAREN GREATER LANSING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANCIOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-975-7555
Mailing Address - Street 1:405 W GREENLAWN AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-2898
Mailing Address - Country:US
Mailing Address - Phone:517-483-4780
Mailing Address - Fax:517-483-7595
Practice Address - Street 1:405 W GREENLAWN AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-2898
Practice Address - Country:US
Practice Address - Phone:517-483-4780
Practice Address - Fax:517-483-7595
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCLAREN GREATER LANSING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP27070Medicare ID - Type Unspecified