Basic Information
| Provider Information | |||||||||
| NPI: | 1427140227 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LASSING | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5987 | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486030987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9894014245 | ||||||||
| FaxNumber: | 9894014235 | ||||||||
| Practice Location | |||||||||
| Address1: | 3400 N CENTER RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486037920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897995600 | ||||||||
| FaxNumber: | 9897997430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 03/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 4301033828 | MI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 32635200 | 05 | WI | MEDICAID | 4830754 | 01 | MI | HEALTHPLAN OF MI | OTHER | 4830754 | 01 | MI | MOLINA HEALTHCARE | OTHER | 4830754 | 05 | MI | MEDICAID | P00290977 | 01 | MI | RAILROAD MEDICARE | OTHER | G36004066 | 01 | MI | MEDICARE PTAN | OTHER |