Healthcare Provider Details

I. General information

NPI: 1083246052
Provider Name (Legal Business Name): MSU HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 S HAGADORN RD STE 500
EAST LANSING MI
48823-6804
US

IV. Provider business mailing address

804 SERVICE RD STE A109B
EAST LANSING MI
48824-7015
US

V. Phone/Fax

Practice location:
  • Phone: 517-432-6144
  • Fax: 517-432-6150
Mailing address:
  • Phone: 517-432-6144
  • Fax: 517-432-6150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: RELANDA PRICE
Title or Position: LEAD ENROLLMENT COORDINATOR
Credential:
Phone: 517-884-2976