Provider Demographics
NPI:1407857758
Name:LANO, MICHAEL DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DENNIS
Last Name:LANO
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 1:7907 POWERS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-9502
Mailing Address - Country:US
Mailing Address - Phone:952-934-0570
Mailing Address - Fax:952-906-7837
Practice Address - Street 1:7907 POWERS BLVD
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-9502
Practice Address - Country:US
Practice Address - Phone:952-934-0570
Practice Address - Fax:952-906-7837
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25217207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN25217OtherMEDICAL LICENSE
MN428503400Medicaid
MN25217OtherMEDICAL LICENSE