Healthcare Provider Details

I. General information

NPI: 1053678268
Provider Name (Legal Business Name): EAST LANSING RHEUMATOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 PINE HOLLOW DR SUITE 400
EAST LANSING MI
48823-9700
US

IV. Provider business mailing address

6200 PINE HOLLOW DR SUITE 400
EAST LANSING MI
48823-9700
US

V. Phone/Fax

Practice location:
  • Phone: 517-339-1676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number5101015197
License Number StateMI

VIII. Authorized Official

Name: JONI ROGNON
Title or Position: OWNER
Credential:
Phone: 517-339-1676