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General NPI Number Information
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NPI Number | 1760561658
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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 | 11/03/2006
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Last Update Date | 06/06/2016
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Provider Practice Location Address
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Address Line | 804 SERVICE RD STE A233
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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 | 517-432-6144
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Fax | 517-432-6150
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Provider Business Mailing Address
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Address Line | D128 WEST FEE HALL
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City | EAST LANSING
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State | MI
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Zip | 48824-1315
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Country | US
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Telephone | 517-355-3503
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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 | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) 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 | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number |
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License Number State |
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