Healthcare Provider Details

I. General information

NPI: 1275273864
Provider Name (Legal Business Name): NATHANIEL MESSENGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 11/06/2026
Certification Date: 11/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 LAKE LANSING RD STE A
LANSING MI
48912-3752
US

IV. Provider business mailing address

1515 LAKE LANSING RD STE A
LANSING MI
48912-3752
US

V. Phone/Fax

Practice location:
  • Phone: 517-487-0128
  • Fax: 517-487-2639
Mailing address:
  • Phone: 517-487-0128
  • Fax: 517-487-2639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4351049379
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: