Healthcare Provider Details

I. General information

NPI: 1518138882
Provider Name (Legal Business Name): JASON COCHRAN DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S PENNSYLVANIA AVE SUITE 204
LANSING MI
48910
US

IV. Provider business mailing address

2815 S PENNSYLVANIA AVE SUITE 204
LANSING MI
48910
US

V. Phone/Fax

Practice location:
  • Phone: 517-267-0200
  • Fax: 517-267-1877
Mailing address:
  • Phone: 517-267-0200
  • Fax: 517-267-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number9041
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2233
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number5101015359
License Number StateMI

VIII. Authorized Official

Name: JASON COCHRAN
Title or Position: OWNER
Credential: DO
Phone: 517-267-0200