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General NPI Number Information
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NPI Number | 1144309642
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Entity Type | Organization
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Legal Business Name | BOARD OF TRUSTEES OF MICHIGAN STATE UNIVERSITY
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 06/04/2021
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Provider Practice Location Address
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Address Line | 463 E CIRCLE DR
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City | EAST LANSING
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State | MI
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Zip | 48824-7500
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Country | US
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Telephone | 517-355-8237
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Fax | 517-432-0457
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Provider Business Mailing Address
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Address Line | 804 SERVICE RD RM A109B
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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 | 517-432-3928
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Authorized Official
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Title or Position | ENROLLMENT & PT ACCTS SUPERVISOR
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Name | LISA RUCKER
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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 | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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