Healthcare Provider Details

I. General information

NPI: 1487981676
Provider Name (Legal Business Name): MICHIGAN STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 S HAGADORN RD SUITE 420
EAST LANSING MI
48823-5376
US

IV. Provider business mailing address

4660 S HAGADORN RD SUITE 420
EAST LANSING MI
48823-5376
US

V. Phone/Fax

Practice location:
  • Phone: 517-884-6100
  • Fax: 517-884-6233
Mailing address:
  • Phone: 517-884-6100
  • Fax: 517-884-6233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA ZALDOKAS
Title or Position: MANAGER CREDENTIALING/ENROLLMENT
Credential:
Phone: 517-355-3503