Healthcare Provider Details

I. General information

NPI: 1437203650
Provider Name (Legal Business Name): MICHAEL A RACINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W GREENLAWN
LANSING MI
48910
US

IV. Provider business mailing address

1031 E SAGINAW STREET
LANSING MI
48906
US

V. Phone/Fax

Practice location:
  • Phone: 517-487-1288
  • Fax: 517-487-1129
Mailing address:
  • Phone: 517-487-1288
  • Fax: 517-487-1129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301079892
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301079892
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: