Healthcare Provider Details

I. General information

NPI: 1053808550
Provider Name (Legal Business Name): DR. ALLISON WOOD, DO MPH, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4136 LEGACY PKWY STE 100
LANSING MI
48911-4293
US

IV. Provider business mailing address

4136 LEGACY PKWY STE 100
LANSING MI
48911-4293
US

V. Phone/Fax

Practice location:
  • Phone: 517-999-5300
  • Fax: 517-999-5310
Mailing address:
  • Phone: 517-999-5300
  • Fax: 517-999-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number5101018021
License Number StateMI

VIII. Authorized Official

Name: ALLISON LEIGH WOOD
Title or Position: OWNER
Credential: DO
Phone: 517-999-5300