Healthcare Provider Details

I. General information

NPI: 1316809163
Provider Name (Legal Business Name): CONNOR GAGE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E JOLLY RD
LANSING MI
48910-6825
US

IV. Provider business mailing address

812 E JOLLY RD STE 210
LANSING MI
48910-6825
US

V. Phone/Fax

Practice location:
  • Phone: 517-237-7162
  • Fax: 517-346-8291
Mailing address:
  • Phone: 517-237-7162
  • Fax: 517-346-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: