Healthcare Provider Details

I. General information

NPI: 1548562853
Provider Name (Legal Business Name): PAMELA CORDEN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 E JOLLY RD STE B
LANSING MI
48910-8552
US

IV. Provider business mailing address

3370 E JOLLY RD STE B
LANSING MI
48910-8552
US

V. Phone/Fax

Practice location:
  • Phone: 517-272-5133
  • Fax: 517-272-5138
Mailing address:
  • Phone: 517-272-5133
  • Fax: 517-272-5138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number5501015438
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: