Provider Demographics
NPI:1811308323
Name:LANSING CARDIOVASCULAR CONSULTANTS PC
Entity type:Organization
Organization Name:LANSING CARDIOVASCULAR CONSULTANTS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-349-3303
Mailing Address - Street 1:3413 WOODS EDGE
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-5901
Mailing Address - Country:US
Mailing Address - Phone:517-349-3303
Mailing Address - Fax:517-349-4374
Practice Address - Street 1:2380 CEDAR ST
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-2143
Practice Address - Country:US
Practice Address - Phone:517-349-3303
Practice Address - Fax:517-349-4374
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANSING CARDIOVASCULAR CONSULTANTS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-19
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704141434207Q00000X
MI4301052584207RC0000X
MI4301063079207U00000X
MI4301063070207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3464783Medicaid
MI4154785Medicaid
MI3043825Medicaid
MI19097861Medicaid
MI0C36097008Medicare PIN
MI3043825Medicaid
MI0C36097Medicare PIN
MI0C36097001Medicare PIN
MI4154785Medicaid