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NPI Code Detail

MEDICARE: CRISTO REY COMMUNITY CENTER

MEDICARE: CRISTO REY COMMUNITY CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology PhysicianSL037010MI
2208D00000XGeneral Practice PhysicianPC049423MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1010C362090OTHERMIBCBS COOKE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407800931
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRISTO REY COMMUNITY CENTER
Provider Business Mailing Address
First Line : 1717 N HIGH ST
Second Line :
City : LANSING
State : MI
Zip : 48906-4529
Country : US
Telephone Number : 517-371-1700
Fax Number : 517-371-4245
Provider Business Practice Location Address
First Line : 1717 N HIGH ST
Second Line :
City : LANSING
State : MI
Zip : 48906-4529
Country : US
Telephone Number : 517-371-1700
Fax Number : 517-371-4245
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. PETER H COOKE
Credential : MD
Telephone Number : 517-371-1700
Provider Enumeration Date : 05/20/2006
Last Update Date : 10/02/2024

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Directions to “CRISTO REY COMMUNITY CENTER ” Practice Location

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