Healthcare Provider Details

I. General information

NPI: 1568105807
Provider Name (Legal Business Name): CONNOR ELDON HOSEY CARE TECH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 E LANSING DR
EAST LANSING MI
48823-7755
US

IV. Provider business mailing address

2775 E LANSING DR
EAST LANSING MI
48823-7755
US

V. Phone/Fax

Practice location:
  • Phone: 855-407-7575
  • Fax:
Mailing address:
  • Phone: 855-407-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1003007550
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: