Provider Demographics
NPI:1588735674
Name:ITO, HIROMICHI (MD)
Entity type:Individual
Prefix:DR
First Name:HIROMICHI
Middle Name:
Last Name:ITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:804 SERVICE RD
Mailing Address - Street 2:A201
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:1200 E MICHIGAN AVENUE
Practice Address - Street 2:SUITE 655
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912
Practice Address - Country:US
Practice Address - Phone:517-267-2460
Practice Address - Fax:517-267-2462
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA216441208600000X
NY2486762086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1588735674Medicaid
MIC36179047Medicare PIN