Individual
MICAH LISSY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4660 S HAGADORN RD STE 420, EAST LANSING, MI 48823-5353
(517) 884-6100
(517) 884-6233
Mailing address
804 SERVICE RD STE A109B, EAST LANSING, MI 48824-7015
(517) 884-6100
(517) 884-6233
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
261158
NY
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
4301099989
MI
Other
Enumeration date
02/04/2011
Last updated
07/26/2022
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