Provider Demographics
NPI:1649290156
Name:GREATER LANSING SURGICAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:GREATER LANSING SURGICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-351-0001
Mailing Address - Street 1:PO BOX 635369
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5369
Mailing Address - Country:US
Mailing Address - Phone:517-336-5176
Mailing Address - Fax:517-336-5475
Practice Address - Street 1:221 W LAKE LANSING RD
Practice Address - Street 2:SUITE 300
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8661
Practice Address - Country:US
Practice Address - Phone:517-351-0001
Practice Address - Fax:517-332-1816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008020208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1649290156OtherNPI
1649290156OtherNPI