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Organization

MICHIGAN STATE UNIVERSITY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RELANDA PRICE (LEAD ENROLLMENT COORDINATOR)
(517) 884-2976
Entity
Organization

Contact information

Practice address
1200 E MICHIGAN AVE, STE 145, LANSING, MI 48912-1837
(517) 364-5440
(517) 364-5466
Mailing address
804 SERVICE RD STE A109B, EAST LANSING, MI 48824-7015
(517) 364-5440
(517) 364-5409

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
207SG0201X
Clinical Genetics (M.D.) Physician
208000000X
Pediatrics Physician
4301050648
MI
2080P0006X
Developmental - Behavioral Pediatrics Physician
2080P0202X
Pediatric Cardiology Physician
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
2080P0208X
Pediatric Infectious Diseases Physician
2080P0214X
Pediatric Pulmonology Physician
2080P0216X
Pediatric Rheumatology Physician

Other

Enumeration date
05/22/2006
Last updated
05/15/2023
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