Provider Demographics
NPI:1235565151
Name:LANSING INSTITUTE OF UROLGOY
Entity Type:Organization
Organization Name:LANSING INSTITUTE OF UROLGOY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-324-3700
Mailing Address - Street 1:1625 RAMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6367
Mailing Address - Country:US
Mailing Address - Phone:517-324-3700
Mailing Address - Fax:517-324-4589
Practice Address - Street 1:1625 RAMBLEWOOD DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6367
Practice Address - Country:US
Practice Address - Phone:517-324-3700
Practice Address - Fax:517-324-4589
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPASS HEALTH, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040634208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C37601Medicare UPIN