Healthcare Provider Details

I. General information

NPI: 1053361089
Provider Name (Legal Business Name): CYNTHIA SPENCER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA AUGUSTINE

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 E JOLLY RD STE G14
LANSING MI
48910-6818
US

IV. Provider business mailing address

812 E JOLLY RD STE 210
LANSING MI
48910-6818
US

V. Phone/Fax

Practice location:
  • Phone: 517-346-8270
  • Fax: 517-346-8291
Mailing address:
  • Phone: 517-346-8410
  • Fax: 517-346-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101012948
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: