Healthcare Provider Details

I. General information

NPI: 1902821671
Provider Name (Legal Business Name): RICHARD ALLEN PITTSLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E LANSING DR SUITE 107
EAST LANSING MI
48823-7787
US

IV. Provider business mailing address

1401 E LANSING DR SUITE 107
EAST LANSING MI
48823-7787
US

V. Phone/Fax

Practice location:
  • Phone: 517-351-8881
  • Fax: 517-351-8883
Mailing address:
  • Phone: 517-351-8881
  • Fax: 517-351-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberRP040011
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: