Provider Demographics
NPI:1750530721
Name:LANSING OSTEOPATHIC MEDICAL GROUP PC
Entity type:Organization
Organization Name:LANSING OSTEOPATHIC MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-482-1183
Mailing Address - Street 1:4655 DOBIE RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2233
Mailing Address - Country:US
Mailing Address - Phone:517-482-1183
Mailing Address - Fax:517-482-9877
Practice Address - Street 1:4655 DOBIE RD
Practice Address - Street 2:SUITE 260
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2233
Practice Address - Country:US
Practice Address - Phone:517-482-1183
Practice Address - Fax:517-482-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006090207Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty