Organization
BOARD OF TRUSTEES OF MICHIGAN STATE UNIVERSITY
Active
Other names
Michigan State University
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
1355 BOGUE STREET, ROOM B123, EAST LANSING, MI 48824-6239
(517) 353-2032
(517) 432-3879
Mailing address
1355 BOGUE STREET, ROOM B123, EAST LANSING, MI 48824-6239
(517) 353-2032
(517) 432-3879
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881849
—
MI
Enumeration date
11/06/2006
Last updated
04/11/2019
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