Provider Demographics
NPI:1639342504
Name:MICHAEL G LASICH PLLC
Entity Type:Organization
Organization Name:MICHAEL G LASICH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:LASICH
Authorized Official - Suffix:
Authorized Official - Credentials:BS,DC
Authorized Official - Phone:1906-226-2510
Mailing Address - Street 1:1009 W RIDGE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-3997
Mailing Address - Country:US
Mailing Address - Phone:906-226-2510
Mailing Address - Fax:906-226-2583
Practice Address - Street 1:1009 W RIDGE ST
Practice Address - Street 2:SUITE B
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-3997
Practice Address - Country:US
Practice Address - Phone:906-226-2510
Practice Address - Fax:906-226-2583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU81265Medicare UPIN
MI0N15140Medicare PIN