Provider Demographics
NPI:1033106372
Name:HANSELMAN, LAUREY R (DO)
Entity Type:Individual
Prefix:DR
First Name:LAUREY
Middle Name:R
Last Name:HANSELMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 N CASEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PIGEON
Mailing Address - State:MI
Mailing Address - Zip Code:48755-9415
Mailing Address - Country:US
Mailing Address - Phone:989-453-2141
Mailing Address - Fax:989-453-4450
Practice Address - Street 1:168 N CASEVILLE RD
Practice Address - Street 2:
Practice Address - City:PIGEON
Practice Address - State:MI
Practice Address - Zip Code:48755-9415
Practice Address - Country:US
Practice Address - Phone:989-453-2141
Practice Address - Fax:989-453-4450
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-03
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILH010698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1033106372OtherNPI
MI4465883Medicaid
MIE90897Medicare UPIN
MIP36730001Medicare PIN