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General NPI Number Information
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NPI Number | 1083666820
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Entity Type | Organization
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Legal Business Name | MICHIGAN STATE UNIVERSITY
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 909 FEE RD ROOM B119
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City | EAST LANSING
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State | MI
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Zip | 48824-6410
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Country | US
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Telephone | 517-353-3070
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Fax | 517-432-3603
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Provider Business Mailing Address
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Address Line | 804 SERVICE RD ROOM A201
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City | EAST LANSING
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State | MI
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Zip | 48824-7015
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Country | US
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Telephone | 517-884-2976
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Fax | 517-432-1167
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT
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Name | KAREN L ROMIG
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Credential |
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Telephone | 517-884-2976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084F0202X
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Taxonomy Name | Forensic Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0005X
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Taxonomy Name | Neurodevelopmental Disabilities Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2084P2900X
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Taxonomy Name | Pain Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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