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General NPI Number Information
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NPI Number | 1033513148
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Entity Type | Organization
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Legal Business Name | EDWARD W SPARROW HOSPITAL ASSOCIATION
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 1540 LAKE LANSING RD SUITE 205
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City | LANSING
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State | MI
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Zip | 48912-3756
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Country | US
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Telephone | 517-913-3910
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Fax |
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Provider Business Mailing Address
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Address Line | 8175 RELIABLE PKWY
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City | CHICAGO
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State | IL
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Zip | 60686-0081
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Country | US
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Telephone | 517-913-3910
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR, PROVIDER ENROLLMENT
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Name | MISTY GUNTER RUSSIAN
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Credential |
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Telephone | 517-253-6308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 1060000091
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License Number State | MI
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