Provider Demographics
NPI:1790803823
Name:ORTHOPAEDIC SPECIALIST OF LANSING PLLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPECIALIST OF LANSING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:SLADEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-374-7022
Mailing Address - Street 1:1000 N HOMER ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912
Mailing Address - Country:US
Mailing Address - Phone:517-374-7022
Mailing Address - Fax:517-374-7554
Practice Address - Street 1:1000 N HOMER ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912
Practice Address - Country:US
Practice Address - Phone:517-374-7022
Practice Address - Fax:517-374-7554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI029042207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1407394Medicaid
MI1407394Medicaid
B47327Medicare UPIN