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Organization
SEDARA MAE HEALTHCARE CLINIC, LLC
Active
Organization
SEDARA MAE HEALTHCARE CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA M LUCAS MSN, APRN-BC (PRACTITIONER)
(800) 363-4661
Entity
Organization
Contact information
Practice address
1167 MADISON AVE SE, MAILBOX 5, GRAND RAPIDS, MI 49507-1200
(616) 301-1020
Mailing address
PO BOX 8862, KENTWOOD, MI 49518-8862
(616) 301-1020
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
4704237090
MI
Other
Enumeration date
04/12/2013
Last updated
04/25/2013
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