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Organization
MICHIGAN STATE UNIVERSITY
Active
Organization
MICHIGAN STATE UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA RUCKER (ENROLLMENT & PATIENT ACCTS MANAGER)
(517) 884-2976
Entity
Organization
Contact information
Practice address
4660 S HAGADORN RD STE 400, EAST LANSING, MI 48823-5353
(517) 355-7648
(517) 432-1319
Mailing address
4660 S HAGADORN RD, STE 400, EAST LANSING, MI 48823-5353
(517) 355-7648
(517) 432-1319
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30675
BCBSM FACILITY PIN
MI
Enumeration date
08/02/2006
Last updated
04/05/2018
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