Healthcare Provider Details

I. General information

NPI: 1588642474
Provider Name (Legal Business Name): NANCY A SPATES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 LAKE LANSING RD SUITE C 2
LANSING MI
48912-3753
US

IV. Provider business mailing address

1515 LAKE LANSING RD SUITE C 2
LANSING MI
48912-3753
US

V. Phone/Fax

Practice location:
  • Phone: 517-482-9582
  • Fax: 517-482-4304
Mailing address:
  • Phone: 517-482-9582
  • Fax: 517-482-4304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301044850
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: