Organization
MICHIGAN STATE UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA M RUCKER (PROVIDER ENROLLMENT MANAGER)
(517) 355-8462
Entity
Organization
Contact information
Practice address
1215 E MICHIGAN AVE, SPARROW HOSPITAL - NEONATOLOGY UNIT, LANSING, MI 48912-1811
(517) 364-2670
(517) 364-3994
Mailing address
804 SERVICE RD, ROOM A201, EAST LANSING, MI 48824-7015
(517) 884-2976
(517) 432-3928
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3043440
—
MI
Enumeration date
10/23/2006
Last updated
02/08/2018
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