Provider Demographics
NPI:1093767816
Name:DUCOMMUN, EDMOND J (MD)
Entity Type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:J
Last Name:DUCOMMUN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1540 LAKE LANSING RD
Mailing Address - Street 2:STE 101
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3707
Mailing Address - Country:US
Mailing Address - Phone:517-913-3810
Mailing Address - Fax:517-913-3811
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:STE 101
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3707
Practice Address - Country:US
Practice Address - Phone:517-913-3810
Practice Address - Fax:517-913-3811
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2019-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301059003208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000001909OtherPHP
MI1010729OtherMCLAREN HEALTH PLAN-MEDICAID
MI4594007OtherAETNA
MIP00464732OtherRAILROAD MEDICARE
MI200000001909OtherPHP FAMILYCARE
MI0250331789OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI1010729OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI4541831Medicaid
MI0M214400029OtherMEDICARE PLUS BLUE
MI1010729OtherMCLAREN HEALTH ADVANTAGE
MI4848089Medicaid
MI1010729OtherMCLAREN HEALTH ADVANTAGE
MI4848089Medicaid