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Organization

MICHIGAN STATE UNIVERSITY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LISA M RUCKER (ENROLLMENT & PATIENT ACCTS MANAGER)
(517) 355-8462
Entity
Organization

Contact information

Practice address
463 EAST CIRCLE DRIVE, RM B35, EAST LANSING, MI 48824-1037
(517) 353-5008
(517) 432-0457
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
261QP2000X
Physical Therapy Clinic/Center
Primary
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
23-6569
OSCAR
MI
Enumeration date
11/03/2006
Last updated
04/05/2018
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