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General NPI Number Information
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NPI Number | 1205955929
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Entity Type | Individual
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Provider Name | RACQUEL BROCKINGTON DO
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Gender | Female
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 1601 E KALAMAZOO ST
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City | LANSING
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State | MI
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Zip | 48912-2701
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Country | US
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Telephone | 517-679-2880
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30161
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City | LANSING
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State | MI
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Zip | 48909-7661
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Country | US
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Telephone | 517-887-4383
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 5101013595
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101013595
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License Number State | MI
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