Healthcare Provider Details

I. General information

NPI: 1083598916
Provider Name (Legal Business Name): LAMIA BAGASRAWALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 E LANSING DR
EAST LANSING MI
48823-7754
US

IV. Provider business mailing address

2650 MARFITT RD APT 1
EAST LANSING MI
48823-6313
US

V. Phone/Fax

Practice location:
  • Phone: 517-337-2900
  • Fax:
Mailing address:
  • Phone: 517-930-7151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number6352001159
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: