Provider Demographics
NPI:1326002494
Name:LANESKY, JOHN R (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:LANESKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 MAIN ST # 46
Mailing Address - Street 2:
Mailing Address - City:BAY HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8023
Mailing Address - Country:US
Mailing Address - Phone:248-342-6570
Mailing Address - Fax:
Practice Address - Street 1:4205 MAIN ST # 46
Practice Address - Street 2:
Practice Address - City:BAY HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49770-8023
Practice Address - Country:US
Practice Address - Phone:248-342-6570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006665208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0425310004OtherDMERC-WARREN OFFICE
MI1262260-11Medicaid
MI0425310003OtherDMERC-MACOMB OFFICE
MICB9133OtherRAILROAD MEDICARE
MI0425310001OtherDMERC-OAKLAND OFFICE
MI0E06273OtherBCBSM
MI0E06273OtherBCBSM
MICB9133OtherRAILROAD MEDICARE