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General NPI Number Information
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NPI Number | 1184707937
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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 | 10/23/2006
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Last Update Date | 04/18/2023
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Provider Practice Location Address
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Address Line | 4660 S HAGADORN RD STE 500
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City | EAST LANSING
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State | MI
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Zip | 48823-5353
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Country | US
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Telephone | 517-884-4554
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Fax | 517-884-4556
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Provider Business Mailing Address
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Address Line | 804 SERVICE RD STE 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 | LEAD ENROLLMENT COORDINATOR
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Name | RELANDA PRICE
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 5901002366
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601003216
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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