Provider Demographics
NPI:1992975064
Name:GARY L CESAR DPM PC
Entity type:Organization
Organization Name:GARY L CESAR DPM PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CESAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM PC
Authorized Official - Phone:517-487-5171
Mailing Address - Street 1:1515 LAKE LANSING RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3752
Mailing Address - Country:US
Mailing Address - Phone:517-487-5171
Mailing Address - Fax:517-371-1366
Practice Address - Street 1:1515 LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3752
Practice Address - Country:US
Practice Address - Phone:517-487-5171
Practice Address - Fax:517-371-1366
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARY L CESAR DPM PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-05
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGC001360213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3012355Medicaid
U21257Medicare UPIN
5335006Medicare PIN
MI0710580001Medicare NSC
0710580001Medicare NSC
MI5335006Medicare PIN