Organization
MICHIGAN STATE UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA RUCKER (ENROLLMENT & PATIENT ACCTS MANAGER)
(517) 355-8462
Entity
Organization
Contact information
Practice address
4660 S HAGADORN RD STE 600, EAST LANSING, MI 48823-5383
(517) 267-2460
(517) 884-8602
Mailing address
804 SERVICE RD STE A109B, EAST LANSING, MI 48824-7015
(517) 267-2460
(517) 884-8602
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207VE0102X
Reproductive Endocrinology Physician
—
—
207Y00000X
Otolaryngology Physician
4301097695
MI
208600000X
Surgery Physician
Primary
—
—
2086S0102X
Surgical Critical Care Physician
—
—
2086S0127X
Trauma Surgery Physician
—
—
2086X0206X
Surgical Oncology Physician
4301077538
MI
Other
Enumeration date
05/11/2006
Last updated
10/18/2019
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