Provider Demographics
NPI:1760792329
Name:LASANTE INC
Entity Type:Organization
Organization Name:LASANTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:L
Authorized Official - Last Name:MIKELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-523-4747
Mailing Address - Street 1:4936 LAVERNA ROAD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62707-9797
Mailing Address - Country:US
Mailing Address - Phone:217-523-4747
Mailing Address - Fax:217-523-0542
Practice Address - Street 1:4936 LAVERNA ROAD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62707-9797
Practice Address - Country:US
Practice Address - Phone:217-523-4747
Practice Address - Fax:217-523-0542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty