Provider Demographics
NPI:1851366124
Name:LASHLEY, PHYLLIS J (MD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:J
Last Name:LASHLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PHYLLIS
Other - Middle Name:J
Other - Last Name:LASHLEY-ALDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:900 PEELER ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2380
Mailing Address - Country:US
Mailing Address - Phone:269-345-8618
Mailing Address - Fax:269-345-1508
Practice Address - Street 1:900 PEELER ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2380
Practice Address - Country:US
Practice Address - Phone:269-345-8618
Practice Address - Fax:269-345-1508
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064862207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3515748Medicaid
MI4858002Medicaid
MIF39033Medicare UPIN
MI3515748Medicaid
MI4858002Medicaid