Healthcare Provider Details

I. General information

NPI: 1619661212
Provider Name (Legal Business Name): MEGAN BROOKS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 S HAGADORN RD STE 500
EAST LANSING MI
48823-6804
US

IV. Provider business mailing address

1141 S WASHINGTON AVE # A
LANSING MI
48910-1648
US

V. Phone/Fax

Practice location:
  • Phone: 517-432-6144
  • Fax:
Mailing address:
  • Phone: 415-244-8570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501016061
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: