MID-MICHIGAN PHYSICIANS, PC

Provider Demographics

• NPI: 1841234457
• Name: MID-MICHIGAN PHYSICIANS, PC
• Entity Type: Organization
• Organization Name: MID-MICHIGAN PHYSICIANS, PC
• Authorized Official - Title/Position: CEO
• Authorized Official - First Name: RAYMOND
• Authorized Official - Last Name: HANSEN
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 517-913-7020
• Mailing Address - Street 1: 2510 KERRY ST.
• Mailing Address - Street 2: STE. 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 103
• Practice Address - City: LANSING
• Practice Address - State: MI
• Practice Address - Zip Code: 48912-3756
• Practice Address - Country: US
• Practice Address - Phone: 517-913-3890
• Practice Address - Fax: 517-913-3891
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-06-15
• Last Update Date: 2011-01-20

Provider Licenses

State	License ID	Taxonomies
MI		207Q00000X, 207R00000X, 207RC0000X, 207RE0101X, 207RH0003X, 207RN0300X, 207U00000X, 207V00000X, 207X00000X, 208100000X, 2083X0100X, 2085R0202X, 208600000X, 363A00000X, 363L00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Multi-Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Multi-Specialty
No	207RC0000X	Allopathic & Osteopathic Physicians	Internal Medicine	Cardiovascular Disease	Group - Multi-Specialty
No	207RE0101X	Allopathic & Osteopathic Physicians	Internal Medicine	Endocrinology, Diabetes & Metabolism	Group - Multi-Specialty
No	207RH0003X	Allopathic & Osteopathic Physicians	Internal Medicine	Hematology & Oncology	Group - Multi-Specialty
No	207RN0300X	Allopathic & Osteopathic Physicians	Internal Medicine	Nephrology	Group - Multi-Specialty
No	207U00000X	Allopathic & Osteopathic Physicians	Nuclear Medicine		Group - Multi-Specialty
No	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology		Group - Multi-Specialty
No	207X00000X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery		Group - Multi-Specialty
No	208100000X	Allopathic & Osteopathic Physicians	Physical Medicine & Rehabilitation		Group - Multi-Specialty
No	2083X0100X	Allopathic & Osteopathic Physicians	Preventive Medicine	Occupational Medicine	Group - Multi-Specialty
No	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology	Group - Multi-Specialty
No	208600000X	Allopathic & Osteopathic Physicians	Surgery		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
MI	110C310710	Other	BCBS/BCN
MI	310C313470	Other	BCBS/BCN
MI	500C311450	Other	BCBS/BCN
MI	700C311100	Other	BCBS/BCN
MI	CE9548	Other	RAILROAD MEDICARE
MI	700C310540	Other	BCBS/BCN
MI	110C310290	Other	BCBS/BCN
MI	540C301890	Other	BCBS DME
MI	CG5949	Other	RAILROAD MEDICARE
MI	020C313990	Other	BCBS
MI	060C313760	Other	BCBS/BCN
MI	700C313280	Other	BCN URGENT CARE GROUP NUMBER
MI	CC3489	Other	RAILROAD MEDICARE
MI	CG3896	Other	RAILROAD MEDICARE
MI	420C317510	Other	BCBS/BCN CERTIFIED MIDWIFE GROUP NUMBER
MI	700C313280	Other	BCN URGENT CARE GROUP NUMBER
MI	0N55170	Medicare ID - Type Unspecified	MEDICARE
MI	CC3489	Other	RAILROAD MEDICARE
MI	0M76680	Medicare ID - Type Unspecified	MEDICARE
MI	0M21440	Medicare ID - Type Unspecified	MEDICARE
MI	CG3896	Other	RAILROAD MEDICARE
MI	310C313470	Other	BCBS/BCN
MI	0P29870	Medicare ID - Type Unspecified	MEDICARE
MI	0M54760	Medicare ID - Type Unspecified	MEDICARE