Provider Demographics
NPI:1558316000
Name:HANDRO, HABTAMU PETROS (MD)
Entity Type:Individual
Prefix:DR
First Name:HABTAMU
Middle Name:PETROS
Last Name:HANDRO
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 1:1540 LAKE LANSING RD
Mailing Address - Street 2:STE 201
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3756
Mailing Address - Country:US
Mailing Address - Phone:517-913-3900
Mailing Address - Fax:517-913-3901
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:STE 201
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3756
Practice Address - Country:US
Practice Address - Phone:517-913-3900
Practice Address - Fax:517-913-3901
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085018207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1022117OtherMCLAREN HEALTH PLAN-COMMERCIAL
MI1103312132OtherBCBS/BCN
MI200000002082OtherPHP FAMILYCARE
MI7125707OtherAETNA
MI0M21440040OtherMEDICARE PLUS BLUE
MIP00254914OtherRAILROAD MEDICARE
MI200000002082OtherPHP
MI1022117OtherMCLAREN HEALTH ADVANTAGE
MI1022117OtherMCLAREN HEALTH PLAN-MEDICAID
MI4741313Medicaid
MI1022117OtherMCLAREN HEALTH ADVANTAGE
MI200000002082OtherPHP