Healthcare Provider Details

I. General information

NPI: 1427443274
Provider Name (Legal Business Name): MICHIGAN STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W GRAND RIVER AVE
EAST LANSING MI
48823
US

IV. Provider business mailing address

620 FARM LANE #341
EAST LANSING MI
48824
US

V. Phone/Fax

Practice location:
  • Phone: 517-355-1900
  • Fax:
Mailing address:
  • Phone: 517-432-8346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA PLAVNICK
Title or Position: DIRECTOR
Credential: PHD
Phone: 517-432-8346