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General NPI Number Information
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NPI Number | 1295978054
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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 | 04/09/2009
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Last Update Date | 04/05/2018
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Provider Practice Location Address
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Address Line | 1355 BOGUE ST RM B228
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City | EAST LANSING
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State | MI
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Zip | 48824-6207
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Country | US
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Telephone | 517-355-4616
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Fax | 517-353-5436
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Provider Business Mailing Address
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Address Line | 1355 BOGUE STREET ROOM B228
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City | EAST LANSING
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State | MI
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Zip | 48824-6239
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Country | US
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Telephone | 517-355-4616
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Fax | 517-353-5436
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Authorized Official
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Title or Position | ENROLLMENT & PATIENT ACCTS MANAGER
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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 | 23D0650872
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License Number State | MI
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