Individual
DR. STACY SUZANNE BULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
463 E CIRCLE DR, EAST LANSING, MI 48824-7500
(517) 884-6502
(517) 355-9265
Mailing address
804 SERVICE RD, # A109F, EAST LANSING, MI 48824-7015
(517) 884-2976
(517) 432-3928
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
4301070974
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0803310501
BCBS INDIVIDUAL PIN
MI
05
—
1619071115
—
MI
05
—
4546883
—
MI
Enumeration date
09/13/2006
Last updated
09/07/2018
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