Healthcare Provider Details

I. General information

NPI: 1487864245
Provider Name (Legal Business Name): BROOKE L LEMMEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 S HAGADORN RD SUITE 420
EAST LALNSING MI
48823
US

IV. Provider business mailing address

1575 RAMBLEWOOD DR
EAST LANSING MI
48823-6384
US

V. Phone/Fax

Practice location:
  • Phone: 517-884-6100
  • Fax: 517-884-6233
Mailing address:
  • Phone: 517-884-2976
  • Fax: 517-432-3928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number5101016768
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101016768
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: