Healthcare Provider Details

I. General information

NPI: 1144967100
Provider Name (Legal Business Name): JUSTINE ANH QUY TRAN-SERRANO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 06/27/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 S HAGADORN RD
EAST LANSING MI
48823-5376
US

IV. Provider business mailing address

4660 S HAGADORN RD
EAST LANSING MI
48823-5376
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number5101028715
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: