Healthcare Provider Details

I. General information

NPI: 1134599046
Provider Name (Legal Business Name): PATRICK H NOUD MD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 S PENNSYLVANIA AVE SUITE 204
LANSING MI
48910-3495
US

IV. Provider business mailing address

2815 S PENNSYLVANIA AVE SUITE 204
LANSING MI
48910-3495
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 TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number4301095240
License Number StateMI

VIII. Authorized Official

Name: LYNDA L UNDERHILL
Title or Position: PRACTICE MANAGER
Credential:
Phone: 517-267-0200