Individual
LARA R CLARY-LANTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
5301 E HURON RIVER DR, YPSILANTI, MI 48197-1051
(734) 712-8676
Mailing address
24 FRANK LLOYD WRIGHT DR, PO BOX 0446 - LOBBY J, ANN ARBOR, MI 48105-9484
(734) 747-6766
(734) 222-3100
Taxonomy
Speciality
Code
Description
License number
State
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
5101018066
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000344854
BLUE CROSS/SHIELD PIN
KY
01
—
2509968
OHIO MEDICAID PIN
OH
05
—
64087901
—
KY
01
—
P00168867
RAILROAD MEDICARE PIN
KY
01
—
P00734129
RAIL ROAD MEDICARE
MI
Enumeration date
11/02/2006
Last updated
07/21/2015
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