# MICHIGAN STATE UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205880333
- **Authorized official:** RELANDA PRICE (LEAD ENROLLMENT COORDINATOR)
- **Authorized official phone:** (517) 884-2976

## Contact information

- **Practice address:** 1200 E MICHIGAN AVE, STE 145, LANSING, MI 48912-1837
- **Practice address phone:** (517) 364-5440
- **Practice address fax:** (517) 364-5466
- **Mailing address:** 804 SERVICE RD STE A109B, EAST LANSING, MI 48824-7015
- **Mailing address phone:** (517) 364-5440
- **Mailing address fax:** (517) 364-5409

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 207SG0201X | Clinical Genetics (M.D.) Physician | — | NULL | — |
| 207SG0201X | Clinical Genetics (M.D.) Physician | — | — | — |
| 208000000X | Pediatrics Physician | 4301050648 | MI | — |
| 2080P0006X | Developmental - Behavioral Pediatrics Physician | — | NULL | — |
| 2080P0006X | Developmental - Behavioral Pediatrics Physician | — | — | — |
| 2080P0202X | Pediatric Cardiology Physician | — | NULL | — |
| 2080P0202X | Pediatric Cardiology Physician | — | — | — |
| 2080P0207X | Pediatric Hematology & Oncology Physician | — | NULL | Yes |
| 2080P0207X | Pediatric Hematology & Oncology Physician | — | — | Yes |
| 2080P0208X | Pediatric Infectious Diseases Physician | — | NULL | — |
| 2080P0208X | Pediatric Infectious Diseases Physician | — | — | — |
| 2080P0214X | Pediatric Pulmonology Physician | — | NULL | — |
| 2080P0214X | Pediatric Pulmonology Physician | — | — | — |
| 2080P0216X | Pediatric Rheumatology Physician | — | NULL | — |
| 2080P0216X | Pediatric Rheumatology Physician | — | — | — |

## Other

- **Enumeration date:** 05/22/2006
- **Last updated:** 05/15/2023