Organization
BOARD OF TRUSTEES OF MICHIGAN STATE UNIVERSITY
Active
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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