Organization
LENISE A. BANSE, M.D.,P.C.
Active
Other names
Northeast Family Dermatology Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LENISE BANSE M.D. (OWNER)
(586) 263-3130
Entity
Organization
Contact information
Practice address
42452 HAYES RD, SUITE 3, CLINTON TOWNSHIP, MI 48038-6771
(586) 263-3130
(586) 263-5183
Mailing address
42452 HAYES RD, SUITE 3, CLINTON TOWNSHIP, MI 48038-6771
(586) 263-3130
(586) 263-5183
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
4301047653
MI
207NP0225X
Pediatric Dermatology Physician
4301047653
MI
207NS0135X
Procedural Dermatology Physician
4301047653
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0500688
BCBS OF MICHIGAN
MA
01
—
0500688001
MEDICARE PLUS BLUE
MI
01
—
0705006881
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
01
—
101151
PREFERRED CHOICES
MA
01
—
101151
CARE CHOICES
MI
01
—
131180573496
HUMANA
MA
01
—
131180573496
HUMANA
MI
01
—
155665
GREAT LAKES HEALTH PLAN
MI
05
—
2806900
—
MI
01
—
4037111
AETNA
MI
01
—
80862B
HEALTH ALLIANCE PLAN
MI
01
—
900013288
PRIORITY HEALTH
MI
01
—
DR500262
MCARE
MI
01
—
MO22874
TRICARE
MI
Enumeration date
01/23/2007
Last updated
06/25/2010
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