MEDICARE: DR. RANDOLPH LESTER PEARSON M.D.

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
1	207Q00000X	Family Medicine Physician	4301045048	MI
2	207QS0010X	Sports Medicine (Family Medicine) Physician	4301045048	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770687998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDOLPH LESTER PEARSON M.D.

Provider Business Mailing Address
First Line	:	1200 E MICHIGAN AVE
Second Line	:	SUITE 245
City	:	LANSING
State	:	MI
Zip	:	48912
Country	:	US
Telephone Number	:	517-364-5710
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 E MICHIGAN AVE STE 245
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48912-1897
Country	:	US
Telephone Number	:	517-364-5710
Fax Number	:	517-364-5718

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2006
Last Update Date	:	12/15/2009

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