Organization
MICHIGAN STATE UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA M RUCKER (ENROLLMENT & PATIENT ACCTS MANAGER)
(517) 355-8462
Entity
Organization
Contact information
Practice address
EAST CIRCLE DR, OLIN HEALTH CENTER, EAST LANSING, MI 48824-1037
(517) 355-4510
Mailing address
804 SERVICE RD STE A109F, EAST LANSING, MI 48824-7015
(517) 884-2976
(517) 432-3928
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0C36058
BCBSM
MI
Enumeration date
05/19/2008
Last updated
04/05/2018
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