Provider Demographics
NPI:1053304600
Name:GALEJS, LARIS EDGAR (MD)
Entity Type:Individual
Prefix:DR
First Name:LARIS
Middle Name:EDGAR
Last Name:GALEJS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8735
Mailing Address - Country:US
Mailing Address - Phone:231-779-2565
Mailing Address - Fax:
Practice Address - Street 1:1011 SUNNYSIDE DR
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8735
Practice Address - Country:US
Practice Address - Phone:231-779-2565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059576208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E06273OtherBCBS,
MICB9133OtherRAILROAD MEDICARE
MICB9133OtherRAILROAD MEDICARE
I62105Medicare UPIN
MI0E06273Medicare Oscar/Certification