| Michigan State University | |
|
804 Service Rd # A225 East Lansing MI 48824-7015 | |
| (517) 353-4941 | |
| Not Available |
| Full Name | Michigan State University |
|---|---|
| Speciality | Family Medicine |
| Location | 804 Service Rd # A225, East Lansing, Michigan |
| Authorized Official Name and Position | Lisa Rucker (MANAGER ENROLLMENT & PATIENT ACCTS) |
| Authorized Official Contact | 5173558462 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michigan State University 804 Service Rd # A109f East Lansing MI 48824-7015 Ph: (517) 884-2976 | Michigan State University 804 Service Rd # A225 East Lansing MI 48824-7015 Ph: (517) 353-4941 |
| NPI Number | 1861443269 |
|---|---|
| Provider Enumeration Date | 05/12/2006 |
| Last Update Date | 02/13/2018 |
| Medicare PECOS PAC ID | 3870405954 |
|---|---|
| Medicare Enrollment ID | O20031105000741 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861443269 | NPI | - | NPPES |
| Provider Name | Saleh A Al Dasouqi |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1710928015 PECOS PAC ID: 8325939234 Enrollment ID: I20040322000793 |
| Provider Name | Robert Charles Smith |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194823534 PECOS PAC ID: 8426949900 Enrollment ID: I20040323001571 |
| Provider Name | David T Walsworth |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346276144 PECOS PAC ID: 0749265296 Enrollment ID: I20040621000444 |
| Provider Name | Reynard Ronald Bouknight |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962444307 PECOS PAC ID: 4183609423 Enrollment ID: I20040622000181 |
| Provider Name | Brian D Smith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629052790 PECOS PAC ID: 5496730269 Enrollment ID: I20040624000258 |
| Provider Name | Diane Macdonald |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1447297742 PECOS PAC ID: 7719950963 Enrollment ID: I20040816001029 |
| Provider Name | Jacob Joseph Rowan |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1063517340 PECOS PAC ID: 7618941733 Enrollment ID: I20040824001098 |
| Provider Name | Raza U Haque |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1336197706 PECOS PAC ID: 3971579558 Enrollment ID: I20040903001132 |
| Provider Name | J'aimee Anne Lippert |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1265465215 PECOS PAC ID: 7416915418 Enrollment ID: I20041222000188 |
| Provider Name | Hend Azhary |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568406874 PECOS PAC ID: 4688625098 Enrollment ID: I20050202001052 |
| Provider Name | Judith Chu Lin |
|---|---|
| Provider Type | Practitioner - Vascular Surgery |
| Provider Identifiers | NPI Number: 1306909932 PECOS PAC ID: 4587607288 Enrollment ID: I20050603000459 |
| Provider Name | Lisa A Destefano |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1336177674 PECOS PAC ID: 7214965417 Enrollment ID: I20050729000164 |
| Provider Name | Todd A Moyer-brailean |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1124095278 PECOS PAC ID: 9234038019 Enrollment ID: I20050914001138 |
| Provider Name | Heather S Laird Fick |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174636823 PECOS PAC ID: 3375577174 Enrollment ID: I20050921000621 |
| Provider Name | Michael Mcleod |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1881663110 PECOS PAC ID: 5991726713 Enrollment ID: I20051208000405 |
| Provider Name | Mark D Ensberg |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912936527 PECOS PAC ID: 2264449172 Enrollment ID: I20060320000007 |
| Provider Name | Edward R Rosick |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1669426516 PECOS PAC ID: 2163433301 Enrollment ID: I20060601000024 |
| Provider Name | Anita R Avery |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1346293693 PECOS PAC ID: 5597778993 Enrollment ID: I20060802000244 |
| Provider Name | Kevin T Foley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750335865 PECOS PAC ID: 5890790299 Enrollment ID: I20060918000380 |
| Provider Name | Paul D Schneider |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1013029917 PECOS PAC ID: 0840296299 Enrollment ID: I20061009000243 |
| Provider Name | Cathleen M Abbott |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275630501 PECOS PAC ID: 4981653946 Enrollment ID: I20061114000446 |
| Provider Name | David P Weismantel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063444784 PECOS PAC ID: 8527066489 Enrollment ID: I20061201000338 |
| Provider Name | Churlsun Han |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326160888 PECOS PAC ID: 6103925540 Enrollment ID: I20070626000115 |
| Provider Name | Michael T Andary |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1952345910 PECOS PAC ID: 3274632468 Enrollment ID: I20070629000125 |
| Provider Name | Julie P Phillips |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609995000 PECOS PAC ID: 3678668019 Enrollment ID: I20071001000519 |
| Provider Name | Mari E Douma |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1871529511 PECOS PAC ID: 9032288527 Enrollment ID: I20080523000482 |
| Provider Name | Joel S Greenberg |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1194838581 PECOS PAC ID: 8628981719 Enrollment ID: I20080721000385 |
| Provider Name | Alyse F Ley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1861609992 PECOS PAC ID: 7517033913 Enrollment ID: I20080909000555 |
| Provider Name | Gary Ferenchick |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891703666 PECOS PAC ID: 3375604911 Enrollment ID: I20081202000086 |
| Provider Name | Deborah B Wagenaar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255315628 PECOS PAC ID: 5496811994 Enrollment ID: I20090309000333 |
| Provider Name | Jennifer Gilmore |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1043228653 PECOS PAC ID: 8527117969 Enrollment ID: I20090514000343 |
| Provider Name | Jim R Sylvain |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1174690523 PECOS PAC ID: 5294782850 Enrollment ID: I20090519000390 |
| Provider Name | William Britt Zimmerman |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1285803627 PECOS PAC ID: 6002967718 Enrollment ID: I20090619000038 |
| Provider Name | Borys Walter Hrinczenko |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1376645085 PECOS PAC ID: 5395725022 Enrollment ID: I20091112000218 |
| Provider Name | Dianne S Singleton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1518941574 PECOS PAC ID: 2264568179 Enrollment ID: I20100330001216 |
| Provider Name | Rachel Christensen |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1992733836 PECOS PAC ID: 0648308908 Enrollment ID: I20100506000355 |
| Provider Name | Christopher A Pohlod |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1154351542 PECOS PAC ID: 8527196898 Enrollment ID: I20100506000390 |
| Provider Name | Kenneth A Schwartz |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1316974405 PECOS PAC ID: 1850420746 Enrollment ID: I20100602000945 |
| Provider Name | Dianne P Wagner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407880792 PECOS PAC ID: 3577692466 Enrollment ID: I20100602000965 |
| Provider Name | Kenneth D Rosenman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235236639 PECOS PAC ID: 0244369080 Enrollment ID: I20100603000610 |
| Provider Name | Jeanette M Scheid |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700870573 PECOS PAC ID: 1254460033 Enrollment ID: I20100604000133 |
| Provider Name | Christine L Shafer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1083698930 PECOS PAC ID: 2961532718 Enrollment ID: I20100604001113 |
| Provider Name | Francesca C Dwamena |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1619913530 PECOS PAC ID: 5799815569 Enrollment ID: I20100605000085 |
| Provider Name | Adesuwa B Olomu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316041668 PECOS PAC ID: 3870623648 Enrollment ID: I20100605000097 |
| Provider Name | Lawrence L Prokop |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1407944747 PECOS PAC ID: 7214067792 Enrollment ID: I20100609000794 |
| Provider Name | Mark R Gugel |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1023021615 PECOS PAC ID: 5395875876 Enrollment ID: I20100609000816 |
| Provider Name | Aron C Sousa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750481529 PECOS PAC ID: 9739219676 Enrollment ID: I20100618000813 |
| Provider Name | Andrew Michael Zwyghuizen |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1861514002 PECOS PAC ID: 8921139122 Enrollment ID: I20100702000401 |
| Provider Name | Robert T Scott |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023141637 PECOS PAC ID: 4082505656 Enrollment ID: I20100806000050 |
| Provider Name | Lionel W Rosen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689658056 PECOS PAC ID: 3476687930 Enrollment ID: I20100819000169 |
| Provider Name | Jed G Magen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619951936 PECOS PAC ID: 5890810345 Enrollment ID: I20100921000626 |
| Provider Name | Farha Z Abbasi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689881781 PECOS PAC ID: 5395938526 Enrollment ID: I20101020001263 |
| Provider Name | Laura E Freilich |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1912189895 PECOS PAC ID: 1759458649 Enrollment ID: I20101102000463 |
| Provider Name | Ryan C Oconnor |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1194714691 PECOS PAC ID: 4385836170 Enrollment ID: I20101118001045 |
| Provider Name | James Hw Clarkson |
|---|---|
| Provider Type | Practitioner - Hand Surgery |
| Provider Identifiers | NPI Number: 1124275698 PECOS PAC ID: 7517156359 Enrollment ID: I20110111000145 |
| Provider Name | Supratik Rayamajhi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013172725 PECOS PAC ID: 3678750932 Enrollment ID: I20110614000389 |
| Provider Name | Kenneth D Stringer |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1891896940 PECOS PAC ID: 4981881240 Enrollment ID: I20110614000445 |
| Provider Name | Robert F Root |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1043472665 PECOS PAC ID: 2163600214 Enrollment ID: I20110621000244 |
| Provider Name | Jennifer Boote |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1518129527 PECOS PAC ID: 3577731819 Enrollment ID: I20110712000693 |
| Provider Name | Nazia Naz Sultan Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1073757845 PECOS PAC ID: 0446428361 Enrollment ID: I20110720000687 |
| Provider Name | Peter J Blakemore |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1821251208 PECOS PAC ID: 7810166618 Enrollment ID: I20110812000147 |
| Provider Name | Emily Schnurr |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720295827 PECOS PAC ID: 8820267594 Enrollment ID: I20110815000332 |
| Provider Name | Harvey L Bumpers |
|---|---|
| Provider Type | Practitioner - Surgical Oncology |
| Provider Identifiers | NPI Number: 1538168463 PECOS PAC ID: 2860672649 Enrollment ID: I20111018000850 |
| Provider Name | Nadir Galal Eldin Abdelrahman |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1417119892 PECOS PAC ID: 1658543517 Enrollment ID: I20111019000159 |
| Provider Name | Srinivas Kavuturu |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1932366309 PECOS PAC ID: 5799821963 Enrollment ID: I20111117000666 |
| Provider Name | Jose Javier Herrera |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1841452604 PECOS PAC ID: 9931365442 Enrollment ID: I20120727000767 |
| Provider Name | Muhammad Nabeel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215265871 PECOS PAC ID: 5395992994 Enrollment ID: I20120905000228 |
| Provider Name | Reddog E Sina |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1902035645 PECOS PAC ID: 2567608904 Enrollment ID: I20130409000570 |
| Provider Name | Nathan C Condie |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1861628430 PECOS PAC ID: 1456599117 Enrollment ID: I20130607000627 |
| Provider Name | Ruby Chahal |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1205148111 PECOS PAC ID: 1456594860 Enrollment ID: I20130904000956 |
| Provider Name | Mathew Aaron Zatkin |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1699086298 PECOS PAC ID: 8426292418 Enrollment ID: I20130912000459 |
| Provider Name | Shilpa Kavuturu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831365170 PECOS PAC ID: 6002002698 Enrollment ID: I20131009001334 |
| Provider Name | Craig E Cole |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700881059 PECOS PAC ID: 0143354076 Enrollment ID: I20131104001597 |
| Provider Name | Melissa Kay Benbow |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1053564617 PECOS PAC ID: 0446480073 Enrollment ID: I20140227001599 |
| Provider Name | Mathew Reza Saffarian |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1356662332 PECOS PAC ID: 9537382643 Enrollment ID: I20140519000520 |
| Provider Name | Rani Issa Gebara |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1588984702 PECOS PAC ID: 2860615606 Enrollment ID: I20140522001760 |
| Provider Name | Jeremiah G Lopez |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1306134085 PECOS PAC ID: 6204051246 Enrollment ID: I20140707000693 |
| Provider Name | Catherine B Donahue |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1003179573 PECOS PAC ID: 1850610445 Enrollment ID: I20150504000533 |
| Provider Name | Richa Tikaria |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1669727715 PECOS PAC ID: 1052631728 Enrollment ID: I20150520000993 |
| Provider Name | John D Tegtmeier |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1285922625 PECOS PAC ID: 6406176841 Enrollment ID: I20150526001833 |
| Provider Name | Christopher T Hannasch |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1194085068 PECOS PAC ID: 9234442518 Enrollment ID: I20150715001260 |
| Provider Name | Harnoor Singh Tokhie |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1154614840 PECOS PAC ID: 0941517361 Enrollment ID: I20150917001916 |
| Provider Name | Mukta Sharma |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710299458 PECOS PAC ID: 1254565393 Enrollment ID: I20151105000638 |
| Provider Name | Jatin Rana |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1699094813 PECOS PAC ID: 4789974726 Enrollment ID: I20160603001540 |
| Provider Name | Clarence Nicodemus |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1063690535 PECOS PAC ID: 9436217270 Enrollment ID: I20160923000188 |
| Provider Name | Mindy Ann Chilman |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1366888448 PECOS PAC ID: 8628357761 Enrollment ID: I20161114001801 |
| Provider Name | Jessica Heselschwerdt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548529340 PECOS PAC ID: 8325267198 Enrollment ID: I20170330002309 |
| Provider Name | Stephanie Bray |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1881892388 PECOS PAC ID: 3274843529 Enrollment ID: I20170825002092 |
| Provider Name | Jesse M Guasco |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548521594 PECOS PAC ID: 3173811841 Enrollment ID: I20170908001919 |
| Provider Name | Arya Khatiwoda |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1609213636 PECOS PAC ID: 7517212046 Enrollment ID: I20180625000249 |
| Provider Name | Lauren Marie Azevedo |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1639557085 PECOS PAC ID: 2860749371 Enrollment ID: I20180716000346 |
| Provider Name | Kevin Joseph Hayes |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1225254477 PECOS PAC ID: 7214080217 Enrollment ID: I20181005000836 |
| Provider Name | Christine Marie Sims |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1730561366 PECOS PAC ID: 5092068866 Enrollment ID: I20181024000885 |
| Provider Name | Archana Bhatt |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1154522472 PECOS PAC ID: 5294827002 Enrollment ID: I20181206003559 |
| Provider Name | Colton C Prudnick |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1619380334 PECOS PAC ID: 5597090597 Enrollment ID: I20190712002237 |
| Provider Name | Daniel Isaac |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1326486416 PECOS PAC ID: 4688805146 Enrollment ID: I20190717000202 |
| Provider Name | Kyle Gerald Mcdonald |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1861842825 PECOS PAC ID: 6709114184 Enrollment ID: I20190822002989 |
Gary H. Dwight, D.d.s., P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 818 W Lake Lansing Rd, East Lansing, MI 48823 Phone: 517-333-9500 Fax: 517-333-9509 | |
Courageous Transformation Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 912 Coolidge Rd, East Lansing, MI 48823 Phone: 517-234-2340 Fax: 517-234-2343 | |
Full Spectrum Family Medicine Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2025 Abbot Rd, Suite 100, East Lansing, MI 48823 Phone: 517-333-3550 Fax: 517-333-8774 | |
Family Care Practice Plc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1675 Watertower Pl, Suite 700, East Lansing, MI 48823 Phone: 517-253-0539 Fax: 517-253-0536 | |
Edward W Sparrow Hospital Association Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2900 Hannah Blvd Ste 104, East Lansing, MI 48823 Phone: 517-364-8000 Fax: 517-364-8001 | |
Nuvoair Medical Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1760 Abbey Rd Fl 2, East Lansing, MI 48823 Phone: 888-915-0624 | |
Main Street Health Partners, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1760 Abbey Rd Fl 2, East Lansing, MI 48823 Phone: 517-305-2470 |