Provider Demographics
NPI:1255444907
Name:LANIGAN, EDWARD DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:DAVID
Last Name:LANIGAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:42 N SAINT JOSEPH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2203
Mailing Address - Country:US
Mailing Address - Phone:269-683-8070
Mailing Address - Fax:269-683-8660
Practice Address - Street 1:42 N SAINT JOSEPH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2203
Practice Address - Country:US
Practice Address - Phone:269-683-8070
Practice Address - Fax:269-683-8660
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2017-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010353652083P0011X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4354697Medicaid
MI1255444907Medicaid
MI0C36088040Medicare PIN
MI4354697Medicaid