Individual
LEI SUN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1215 E MICHIGAN AVE, LANSING, MI 48912-1811
(517) 364-5710
Mailing address
1215 E MICHIGAN AVE, LANSING, MI 48912-1811
(517) 364-5710
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5151014288
MI
Other
Enumeration date
04/29/2020
Last updated
04/29/2020
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