Active NPI
Lenise a. Banse, M.D.,P.C.
- Dermatology Physician
- Clinton Township, MI
National Provider Identifier
1811041890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 4301047653
- Legal business name
- LENISE A. BANSE, M.D.,P.C.
- Practice address
- 42452 Hayes Rd
Suite 3
Clinton Township, MI 48038-6771 - Phone
- (586) 263-3130
- Fax
- (586) 263-5183
- NPI assigned
- Jan 23, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Lenise Banse, M.D.
- Title
- Owner
- Phone
- (586) 263-3130
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 4301047653 | MI | Primary |
| Pediatric Dermatology Physician | 207NP0225X | 4301047653 | MI | |
| Procedural Dermatology Physician | 207NS0135X | 4301047653 | MI |
Addresses
Primary practice location
42452 Hayes Rd
Suite 3
Clinton Township, MI 48038-6771
Mailing address
42452 Hayes Rd
Suite 3
Clinton Township, MI 48038-6771
Phone (586) 263-3130
Other identifiers 14
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101151 | Other | MA | PREFERRED CHOICES |
| 0500688 | Other | MA | BCBS OF MICHIGAN |
| 4037111 | Other | MI | AETNA |
| 131180573496 | Other | MA | HUMANA |
| DR500262 | Other | MI | MCARE |
| 0705006881 | Other | MI | BLUE CROSS BLUE SHIELD OF MICHIGAN |
| 900013288 | Other | MI | PRIORITY HEALTH |
| 101151 | Other | MI | CARE CHOICES |
| 131180573496 | Other | MI | HUMANA |
| 155665 | Other | MI | GREAT LAKES HEALTH PLAN |
| 0500688001 | Other | MI | MEDICARE PLUS BLUE |
| 2806900 | Medicaid | MI | |
| 80862B | Other | MI | HEALTH ALLIANCE PLAN |
| MO22874 | Other | MI | TRICARE |
Other names 1
- Northeast Family Dermatology Center
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169510400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1277424000000",
"number": "1811041890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "42452 HAYES RD",
"address_2": "SUITE 3",
"city": "CLINTON TOWNSHIP",
"state": "MI",
"postal_code": "480386771",
"telephone_number": "586-263-3130",
"fax_number": "586-263-5183"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "42452 HAYES RD",
"address_2": "SUITE 3",
"city": "CLINTON TOWNSHIP",
"state": "MI",
"postal_code": "480386771",
"telephone_number": "586-263-3130",
"fax_number": "586-263-5183"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LENISE A. BANSE, M.D.,P.C.",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-23",
"last_updated": "2010-06-25",
"status": "A",
"authorized_official_last_name": "BANSE",
"authorized_official_first_name": "LENISE",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "586-263-3130",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Dermatology",
"state": "MI",
"license": "4301047653",
"primary": true
},
{
"code": "207NP0225X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Dermatology, Pediatric Dermatology",
"state": "MI",
"license": "4301047653",
"primary": false
},
{
"code": "207NS0135X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Dermatology, Procedural Dermatology",
"state": "MI",
"license": "4301047653",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED CHOICES",
"identifier": "101151",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MICHIGAN",
"identifier": "0500688",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4037111",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "131180573496",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCARE",
"identifier": "DR500262",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD OF MICHIGAN",
"identifier": "0705006881",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIORITY HEALTH",
"identifier": "900013288",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARE CHOICES",
"identifier": "101151",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "131180573496",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GREAT LAKES HEALTH PLAN",
"identifier": "155665",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PLUS BLUE",
"identifier": "0500688001",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2806900",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE PLAN",
"identifier": "80862B",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "MO22874",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Northeast Family Dermatology Center",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Clinton Township, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.