Basic Information
| Provider Information | |||||||||
| NPI: | 1326059031 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HONICKY | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1540 LAKE LANSING RD | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489123756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179133800 | ||||||||
| FaxNumber: | 5179133801 | ||||||||
| Practice Location | |||||||||
| Address1: | 1540 LAKE LANSING RD | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489123756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179133800 | ||||||||
| FaxNumber: | 5179133801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 10/14/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0214X | 4301036851 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology |
ID Information
| ID | Type | State | Issuer | Description | P00848493 | 01 | MI | MEDICARE RAILROD | OTHER | 1038849 | 01 | MI | MCLAREN HEALTH ADVANTAGE | OTHER | 1038849 | 01 | MI | MCLAREN HEALTH PLAN-COMMERCIAL | OTHER | 4322962 | 01 | MI | AETNA | OTHER | 3503352731 | 01 | MI | BLUE CROSS BLUE SHIELD OF MICHIGAN | OTHER | 0M21440065 | 01 | MI | MEDICARE PLUS BLUE | OTHER | 1038849 | 01 | MI | MCLAREN HEALTH PLAN-MEDICAID | OTHER | 200000021303 | 01 | MI | PHP | OTHER | 200000021303 | 01 | MI | PHP FAMILYCARE | OTHER |