Healthcare Provider Details

I. General information

NPI: 1326731050
Provider Name (Legal Business Name): HEALTHY COCOON PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27082 W. MAIN STREET
EDWARDSBURG MI
49112
US

IV. Provider business mailing address

27082 W. MAIN STREET
EDWARDSBURG MI
49112
US

V. Phone/Fax

Practice location:
  • Phone: 269-246-1375
  • Fax: 269-246-1376
Mailing address:
  • Phone: 269-246-1375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LINDSEY D. LIRA
Title or Position: OWNER
Credential: MD
Phone: 269-246-1375