Basic Information
| Provider Information | |||||||||
| NPI: | 1558316000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANDRO | ||||||||
| FirstName: | HABTAMU | ||||||||
| MiddleName: | PETROS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1540 LAKE LANSING RD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489123756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179133900 | ||||||||
| FaxNumber: | 5179133901 | ||||||||
| Practice Location | |||||||||
| Address1: | 1540 LAKE LANSING RD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489123756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179133900 | ||||||||
| FaxNumber: | 5179133901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 09/22/2009 | ||||||||
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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 | 207R00000X | 4301085018 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1022117 | 01 | MI | MCLAREN HEALTH PLAN-COMMERCIAL | OTHER | 1103312132 | 01 | MI | BCBS/BCN | OTHER | 200000002082 | 01 | MI | PHP FAMILYCARE | OTHER | 7125707 | 01 | MI | AETNA | OTHER | 0M21440040 | 01 | MI | MEDICARE PLUS BLUE | OTHER | P00254914 | 01 | MI | RAILROAD MEDICARE | OTHER | 200000002082 | 01 | MI | PHP | OTHER | 1022117 | 01 | MI | MCLAREN HEALTH ADVANTAGE | OTHER | 1022117 | 01 | MI | MCLAREN HEALTH PLAN-MEDICAID | OTHER | 4741313 | 05 | MI | MEDICAID |