Provider Demographics
NPI:1376638429
Name:LANSING INSTITUTE OF UROLOGY , P.C.
Entity Type:Organization
Organization Name:LANSING INSTITUTE OF UROLOGY , P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZUCKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-324-3700
Mailing Address - Street 1:3725 BEECH TREE LN
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3871
Mailing Address - Country:US
Mailing Address - Phone:517-349-9449
Mailing Address - Fax:
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
340C376010OtherBLUE CROSS BLUE SHIELD
CM8480OtherRAILROAD MEDICARE
340C376010OtherBLUE CROSS BLUE SHIELD
340C376010OtherBLUE CROSS BLUE SHIELD
MI0C37601Medicare ID - Type Unspecified