Individual
MARIO DANTE LACERNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1501 W CHISHOLM ST, ALPENA, MI 49707-1401
(888) 356-7151
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
4301059592
MI
2085R0001X
Radiation Oncology Physician
ME111595
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4303114
—
MI
05
—
4375200
—
FL
01
—
FT108Y
MEDICARE
FL
Enumeration date
09/29/2006
Last updated
11/08/2024
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