Provider Demographics
NPI:1619058757
Name:LANSING RHEUMATOLOGY PLLC
Entity Type:Organization
Organization Name:LANSING RHEUMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NITI
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-339-1676
Mailing Address - Street 1:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48826-0259
Mailing Address - Country:US
Mailing Address - Phone:517-339-1676
Mailing Address - Fax:517-339-2716
Practice Address - Street 1:6200 PINE HOLLOW DR
Practice Address - Street 2:SUITE 400
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-9700
Practice Address - Country:US
Practice Address - Phone:517-339-1676
Practice Address - Fax:517-339-2716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055581207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P15480Medicare PIN