Provider Demographics
NPI:1720227739
Name:DR. WESLEY C. LOCKHART, PC
Entity Type:Organization
Organization Name:DR. WESLEY C. LOCKHART, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-203-0183
Mailing Address - Street 1:PO BOX 1207
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48826-1207
Mailing Address - Country:US
Mailing Address - Phone:517-203-0183
Mailing Address - Fax:
Practice Address - Street 1:3394 E JOLLY RD
Practice Address - Street 2:SUITE D
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-8594
Practice Address - Country:US
Practice Address - Phone:517-203-0183
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012587204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OM94270Medicare PIN
MIE32305Medicare UPIN