Provider Demographics
NPI:1659677607
Name:MID-MICHIGAN PHYSICIANS, PC
Entity Type:Organization
Organization Name:MID-MICHIGAN PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-913-7020
Mailing Address - Street 1:2510 KERRY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3658
Mailing Address - Country:US
Mailing Address - Phone:517-913-7020
Mailing Address - Fax:517-913-7022
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:SUITE 203
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3756
Practice Address - Country:US
Practice Address - Phone:517-913-3855
Practice Address - Fax:517-913-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty