MICHIGAN STATE UNIVERSITY (NPI# 1326121179) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326121179 |
| Entity Type | Organization |
| Organization Name | MICHIGAN STATE UNIVERSITY |
| Practice Address |
1600 W Grand River Ave Ste 2 Okemos MI 48864-2394 |
| Mailing Address |
804 Service Rd # A109f East Lansing MI 48824-7015 |
| Practice Telephone | 5173496560 |
| Practice Fax Number | 5173485796 |
| Mailing Telephone | 5178842976 |
| Mailing Fax Number | 5174323928 |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2018-04-05 |
| Authorized Official Name | LISA M RUCKER (PROVIDER ENROLLMENT MANAGER) |
| Authorized Official Telephone | 5173558462 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| N | 204D00000X | Neuromusculoskeletal Medicine & OMM | Allopathic & Osteopathic Physicians | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207SG0201X |
Medical Genetics Specialization: Clinical Genetics (M.D.) |
5101011076 | MI | Allopathic & Osteopathic Physicians |
| N | 207SG0201X |
Medical Genetics Specialization: Clinical Genetics (M.D.) |
Allopathic & Osteopathic Physicians | ||
| N | 207XP3100X |
Orthopaedic Surgery Specialization: Pediatric Orthopaedic Surgery |
5101019945 | MI | Allopathic & Osteopathic Physicians |
| N | 2080P0208X |
Pediatrics Specialization: Pediatric Infectious Diseases |
Allopathic & Osteopathic Physicians | ||
| N | 208100000X | Physical Medicine & Rehabilitation | Allopathic & Osteopathic Physicians | ||
| N | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 208800000X | Urology | Allopathic & Osteopathic Physicians | ||
| N | 2088P0231X |
Urology Specialization: Pediatric Urology |
Allopathic & Osteopathic Physicians | ||
| Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184182982 | Michigan State University | Local Education Agency (LEA) | 446 W. Circle Drive, Room 409, Justin S. Morrill Hall of Agriculture, East Lansing, MI 48824-1039 | 2019-03-11 |
| 1427443274 | Michigan State University | Behavioral Analyst | 325 W Grand River Ave, East Lansing, MI 48823 | 2015-03-30 |
| 1629307251 | Michigan State University | Preventive Medicine | 346 Olin Health Ctr, East Circle Drive, East Lansing, MI 48824-1037 | 2009-12-10 |
| 1295978054 | Michigan State University | Clinical Medical Laboratory | 1355 Bogue St Rm B228, East Lansing, MI 48824-6207 | 2009-04-09 |
| 1487780565 | Michigan State University | Clinical Medical Laboratory | B228 Life Sciences Bldg, East Lansing, MI 48824 | 2007-02-26 |
| 1518046598 | Michigan State University | Clinic/Center | 804 Clinical Center, A114, East Lansing, MI 48824-1313 | 2006-11-02 |
| 1639253784 | Michigan State University | Registered Nurse | 804 Service Rd Ste A142, East Lansing, MI 48824-7015 | 2006-10-25 |
| 1962515221 | Michigan State University | Pharmacy | 463 E Circle Dr. Rm103, East Lansing, MI 48824 | 2006-08-17 |
| 1992712053 | Michigan State University | Occupational Therapist | 4660 S Hagadorn Rd Ste 400, East Lansing, MI 48823-5353 | 2006-08-02 |
| 1891747614 | Michigan State University | Radiology | 804 Service Rd # D100, East Lansing, MI 48824-7015 | 2006-05-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MICHIGAN STATE UNIVERSITY | 426 Auditorium Rd, East Lansing, MI 48824-2600 |
| Massachusetts Corporations | MICHIGAN STATE UNIVERSITY ALUMNI CLUB OF BOSTON, INC. | 2001 Dogwood Circle, North Andover, MA 01845 |
| Virginia Business Entities | Michigan State University Alumni Club of Metropolitan Washington DC | 10511 Judicial Drive, Fairfax, Virginia 22030-5172 |
| System for Award Management (SAM) Entities | MICHIGAN STATE UNIVERSITY FOUNDATION | 2727 Alliance Dr Ste C, Lansing, MI 48910-3868 |
| Street Address |
1600 W GRAND RIVER AVE STE 2 |
| City | OKEMOS |
| State | MI |
| Zip Code | 48864-2394 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437102357 | Edward W. Sparrow Hospital Association | Family Medicine | 1600 W Grand River Ave, Suite 4, Okemos, MI 48864-2394 | 2006-05-19 |
| 1265525356 | Terri Kay Meunier | Family Medicine | 1600 W Grand River Ave, Okemos, MI 48864-2394 | 2006-10-02 |
| 1336231067 | Michael Kermit Mcalvey | Family Medicine | 1600 W Grand River Ave, Okemos, MI 48864-2394 | 2006-09-29 |
| 1245321322 | Angela C Griffin | Obstetrics & Gynecology | 1600 W Grand River Ave, Suite 1, Okemos, MI 48864-2394 | 2006-09-27 |
| 1891896940 | Kenneth D Stringer | Pediatrics | 1600 W Grand River Ave, Suite 2, Okemos, MI 48864-2394 | 2006-09-25 |
| 1831294016 | Jan Q Wu | Family Medicine | 1600 W Grand River Ave, Suite 4, Okemos, MI 48864-2394 | 2006-09-13 |
| 1447274659 | Kathleen M. Waldron | Family Medicine | 1600 W Grand River Ave, Suite 4, Okemos, MI 48864-2394 | 2006-07-27 |
| 1538191259 | Hiram Stephen Williams | Pediatrics | 1600 W Grand River Ave, Okemos, MI 48864-2394 | 2006-07-06 |
| 1669414116 | Gerard Martin Breitzer | Pediatrics | 1600 W Grand River Ave, Ste 2, Okemos, MI 48864-2394 | 2006-06-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972066348 | Jan J Stokosa | Prosthetic/Orthotic Supplier | 2145 University Park Drive, Suite 100, Okemos, MI 48864 | 2019-04-11 |
| 1194284067 | Bryan R Salminen | Counselor | 2127 University Drive Suite 300, Okemos, MI 48864 | 2019-03-19 |
| 1639678600 | Paula Veronica Yevilaf Neira | Behavior Technician | 3887 Okemos Rd Suite A1, Okemos, MI 48864 | 2018-02-06 |
| 1306364690 | Sally Ann Purdy | Social Worker | 3493 Woods Edge Dr., Suite #103, Okemos, MI 48864 | 2017-09-06 |
| 1952824609 | Victoria Marie Hopper | Behavior Technician | 3887 Okemos Rd., Suite #a1, Okemos, MI 48864 | 2017-07-24 |
| 1134653306 | Kayleigh Delaney | Dietitian, Registered | 5050 Marsh Road, Suite 5, Okemos, MI 48864 | 2017-04-14 |
| 1922544402 | Elsabeth Engeda | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4464 Hickory Drive, Okemos, MI 48864 | 2017-01-09 |
| 1104373752 | Joslyn Fraidenburg | Registered Nurse | 2322 Knod Hill Dr, Apt 14, Okemos, MI 48864 | 2016-09-01 |
| 1851748966 | Doug Derdowski | Social Worker | 4123 Okemos Road, Eastbrook Plaza, Okemos, MI 48864 | 2016-05-18 |
| 1437505971 | Jessica Lynn Reslock | Occupational Therapist | 2378 Woodlake Dr. Suite 280, Children's Therapy Corner, Okemos, MI 48864 | 2016-05-13 |
| Find all providers in zip 48864 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639557085 | Lauren Marie Azevedo | Pediatrics | 1600 W Grand River Ave Ste 2, Okemos, MI 48864 | 2015-05-18 |
| 1134542400 | Jerold Paul Veldman | Pediatrics | 4436 Copperhill Dr, Okemos, MI 48864-2000 | 2014-01-22 |
| 1437184207 | Ruth Ann Worthington | Pediatrics | 1600 W Gd River Ave, Ste 2, Okemos, MI 48864 | 2006-07-11 |
| 1902077480 | James A Brouillette | Pediatrics | 2445 Jolly Rd, Okemos, MI 48864-4590 | 2008-03-12 |
| 1194866046 | Eleanor A Watson | Pediatrics | 2445 Jolly Rd, Suite 300, Okemos, MI 48864-4590 | 2007-02-12 |
| 1891896940 | Kenneth D Stringer | Pediatrics | 1600 W Grand River Ave, Suite 2, Okemos, MI 48864-2394 | 2006-09-25 |
| 1538191259 | Hiram Stephen Williams | Pediatrics | 1600 W Grand River Ave, Okemos, MI 48864-2394 | 2006-07-06 |
| 1669414116 | Gerard Martin Breitzer | Pediatrics | 1600 W Grand River Ave, Ste 2, Okemos, MI 48864-2394 | 2006-06-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700498946 | Positively Pediatrics Pllc | Pediatrics | 120 N Bridge St Ste D, Linden, MI 48451-8823 | 2020-08-19 |
| 1730708058 | Xuexin Lu | Pediatrics | 22101 Moross Rd Ste 80, Detroit, MI 48236-2148 | 2020-04-16 |
| 1083252324 | Faith Cares Inc | Pediatrics | 9633 Sil St, Taylor, MI 48180-3028 | 2019-12-17 |
| 1013560473 | Muhammad Waqas | Pediatrics | Beaumont Hospital Royal Oak, 3601 W 13 Mile Rd, Royal Oak, MI 48073 | 2019-07-24 |
| 1528611175 | Emad Kassas | Pediatrics | 358 E Chicago St Ste C, Coldwater, MI 49036-2072 | 2019-07-23 |
| 1457911877 | Zachary Todd Goldstein | Pediatrics | Cedar Pediatrics 5303 S. Cedar St, Suite 205, Lansing, MI 48911 | 2019-06-18 |
| 1811553597 | Emile Muallem | Pediatrics | 1500 E. Med. Ctr Dr, Ann Arbor, MI 48109-5718 | 2019-05-17 |
| 1215403597 | Mfed Mosely | Pediatrics | 21840 23rd Mile Road, Macomb Twnp, MI 48040-2496 | 2018-10-15 |
| 1811473234 | Joyful Pediatrics, Pllc | Pediatrics | 820 Byron Rd Ste 600, Howell, MI 48843-1072 | 2018-07-18 |
| 1386139913 | Southfield Pediatrics Pllc | Pediatrics | 28500 Southfield Rd Ste 100, Lathrup Village, MI 48076-2722 | 2018-06-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.