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Organization
BOARD OF TRUSTEES OF MICHIGAN STATE UNIVERSITY
Active
Organization
BOARD OF TRUSTEES OF MICHIGAN STATE UNIVERSITY
Active
Other names
MSU CMDS CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
LISA M RUCKER (ENROLLMENT & PATIENT ACCTS SUPER)
(517) 355-8462
Entity
Organization
Contact information
Practice address
1200 E MICHIGAN AVE, STE 145, LANSING, MI 48912-1800
(517) 364-5440
(517) 364-5409
Mailing address
804 SERVICE RD STE A109B, EAST LANSING, MI 48824-7015
(517) 884-2976
(517) 432-3928
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
4301035591
MI
207RH0003X
Hematology & Oncology Physician
4301021298
MI
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
4301045225
MI
2080P0214X
Pediatric Pulmonology Physician
4301035591
MI
Other
Enumeration date
10/31/2014
Last updated
12/13/2019
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