Individual
DR. PHILIP J. LANZISERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
HENRY FORD HEALTH SYSTEM, ONE FORD PLACE 1F -BEHAVIORAL, DETROIT, MI 48202
(313) 876-6677
(313) 874-6650
Mailing address
HENRY FORD HEALTH SYSTEM, ONE FORD PLACE 1F -BEHAVIORAL, DETROIT, MI 48202
(313) 876-6677
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6301001788
MI
103TC0700X
Clinical Psychologist
Primary
6301001788
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700H262290
BLUE CROSS-BLUE CROSS
—
05
—
PHD888810
—
MI
01
—
PL001788
COMMERCIAL-COMMERCIAL NUMBER
—
Enumeration date
01/08/2007
Last updated
06/15/2023
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