Healthcare Provider Details

I. General information

NPI: 1386731545
Provider Name (Legal Business Name): GREGORY G MESSENGER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2006
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 LAKE LANSING RD SUITE A
LANSING MI
48912-3753
US

IV. Provider business mailing address

1515 LAKE LANSING RD SUITE A
LANSING MI
48912-3753
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 TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number StateMI
# 7
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. GREGORY G MESSENGER
Title or Position: OWNER
Credential: MD
Phone: 517-487-0128