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General NPI Number Information
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NPI Number | 1972928513
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Entity Type | Organization
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Legal Business Name | GERALD T PRUITT DO PLLC
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Dates
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Enumeration Date | 02/19/2014
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 350 WHITEHILLS DR
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City | EAST LANSING
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State | MI
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Zip | 48823-2758
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Country | US
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Telephone | 517-455-7155
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Fax |
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Provider Business Mailing Address
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Address Line | 350 WHITEHILLS DR
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City | EAST LANSING
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State | MI
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Zip | 48823-2758
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Country | US
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Telephone | 517-455-7155
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | MS. MALIA B PRUITT
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Credential |
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Telephone | 517-455-7155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 5101015307
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License Number State | MI
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