Individual
DR. EDMOND J. DUCOMMUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1540 LAKE LANSING RD, STE 101, LANSING, MI 48912-3707
(517) 913-3810
(517) 913-3811
Mailing address
1540 LAKE LANSING RD, STE 101, LANSING, MI 48912-3707
(517) 913-3810
(517) 913-3811
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
4301059003
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0250331789
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
01
—
0M214400029
MEDICARE PLUS BLUE
MI
01
—
1010729
MCLAREN HEALTH PLAN-MEDICAID
MI
01
—
200000001909
PHP
MI
05
—
4541831
—
MI
01
—
4594007
AETNA
MI
05
—
4848089
—
MI
01
—
P00464732
RAILROAD MEDICARE
MI
Enumeration date
05/17/2006
Last updated
09/03/2019
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