Healthcare Provider Details

I. General information

NPI: 1245429190
Provider Name (Legal Business Name): SPARROW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E MOUNT HOPE AVE
LANSING MI
48910-3207
US

IV. Provider business mailing address

5400 MALL DR W APT 3107
LANSING MI
48917-3260
US

V. Phone/Fax

Practice location:
  • Phone: 517-485-1153
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number4301087677
License Number StateMI

VIII. Authorized Official

Name: CYNTHIA ZALDOKAS
Title or Position: COORDINATOR
Credential:
Phone: 517-355-3503