Healthcare Provider Details

I. General information

NPI: 1710633607
Provider Name (Legal Business Name): GREGORY DOUGLAS DAGNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

913 W HOLMES RD STE 200
LANSING MI
48910-0411
US

IV. Provider business mailing address

913 W HOLMES RD STE 200
LANSING MI
48910-0411
US

V. Phone/Fax

Practice location:
  • Phone: 517-887-0226
  • Fax:
Mailing address:
  • Phone: 517-887-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: