Individual
CARMEN R VENTOCILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3960 PATIENT CARE WAY, SUITE 102, LANSING, MI 48911-4275
(517) 351-8123
(517) 351-1352
Mailing address
3960 PATIENT CARE WAY, SUITE 102, LANSING, MI 48911-4275
(517) 351-8123
(517) 351-1352
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
CV405064
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0331111
BCBSM
MI
01
—
25008734
RAILROAD MEDICARE
MI
Enumeration date
05/11/2006
Last updated
10/29/2007
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