Organization
BOARD OF TRUSTEES OF MICHIGAN STATE UNIVERSITY
Active
Other names
MSU CMDS CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
LISA M RUCKER (ENROLLMENT & PATIENT ACCTS SUPER)
(517) 355-8462
Entity
Organization
Contact information
Practice address
1200 E MICHIGAN AVE, STE 145, LANSING, MI 48912-1800
(517) 364-5440
(517) 364-5409
Mailing address
804 SERVICE RD STE A109B, EAST LANSING, MI 48824-7015
(517) 884-2976
(517) 432-3928
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
4301035591
MI
207RH0003X
Hematology & Oncology Physician
4301021298
MI
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
4301045225
MI
2080P0214X
Pediatric Pulmonology Physician
4301035591
MI
Other
Enumeration date
10/31/2014
Last updated
12/13/2019
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