Healthcare Provider Details

I. General information

NPI: 1629282538
Provider Name (Legal Business Name): DR. DEREK STEELE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 EAST MICHIGAN AVENUE
LANSING MI
48912
US

IV. Provider business mailing address

3723 KIKSADEE DR
EAST LANSING MI
48823
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301080666
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: