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Organization
MICHIGAN STATE UNIVERSITY
Active
Organization
MICHIGAN STATE UNIVERSITY
Active
Other names
Family Practice Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA M RUCKER (PROVIDER ENROLLMENT MANAGER)
(517) 355-8462
Entity
Organization
Contact information
Practice address
804 SERVICE RD # A201, EAST LANSING, MI 48824-7015
(517) 884-2976
(517) 432-3928
Mailing address
804 SERVICE RD # A201A, EAST LANSING, MI 48824-7015
(517) 884-2976
(517) 432-3928
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
NULL
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
—
NULL
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
Other
Enumeration date
10/23/2006
Last updated
02/08/2018
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