Healthcare Provider Details

I. General information

NPI: 1093927980
Provider Name (Legal Business Name): BONNIE J SEAKS P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

E CIRCLE DR OLIN HEALTH CENTER UNIVERSITY PHYSICIANS OFFICE
EAST LANSING MI
48824
US

IV. Provider business mailing address

D128 W FEE HALL
EAST LANSING MI
48824-1315
US

V. Phone/Fax

Practice location:
  • Phone: 517-353-9101
  • Fax: 517-355-0332
Mailing address:
  • Phone: 517-355-3503
  • Fax: 517-432-1167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601001375
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: