Basic Information
| Provider Information | |||||||||
| NPI: | 1871110833 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEMANSKI | ||||||||
| FirstName: | MARK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 WELLNESS DRIVE | ||||||||
| Address2: | MIDLAND MALL | ||||||||
| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8448321956 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4611 CAMPUS RIDGE DR | ||||||||
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| City: | MIDLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486409533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8983935009 | ||||||||
| FaxNumber: | 9898391869 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2020 | ||||||||
| LastUpdateDate: | 07/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4351049339 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.