MICHIGAN STATE UNIVERSITY (NPI# 1568545218) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568545218 |
| Entity Type | Organization |
| Organization Name | MICHIGAN STATE UNIVERSITY |
| Other Organization Name | FAMILY PRACTICE CLINIC |
| Practice Address |
804 Service Rd # A201 East Lansing MI 48824-7015 |
| Mailing Address |
804 Service Rd # A201a East Lansing MI 48824-7015 |
| Practice Telephone | 5178842976 |
| Practice Fax Number | 5174323928 |
| Mailing Telephone | 5178842976 |
| Mailing Fax Number | 5174323928 |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2018-02-08 |
| Authorized Official Name | MRS. 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 | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207QG0300X |
Family Medicine Specialization: Geriatric Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 2080N0001X |
Pediatrics Specialization: Neonatal-Perinatal Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Family Practice Clinic | Other Name - Individual/Organization |
| 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 |
804 SERVICE RD # A201 |
| City | EAST LANSING |
| State | MI |
| Zip Code | 48824-7015 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376645085 | Borys W Hrinczenko | Internal Medicine | 804 Service Rd # A201, East Lansing, MI 48824-7015 | 2006-09-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528680303 | Emilia Elizabeth Mattioli | Psychiatry & Neurology | 965 Fee Road Room A223, East Lansing, MI 48824 | 2020-05-14 |
| 1447871983 | James O'brien | Psychiatry & Neurology | Msu Psychiatry Residency Program, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2020-05-06 |
| 1750916979 | Mulin Xiong | Student in an Organized Health Care Education/Training Program | 965 Wilson Road Suite A110, East Fee Hall, East Lansing, MI 48824 | 2020-03-09 |
| 1821659301 | Tovah Apolonia Aho | Psychiatry & Neurology | Michigan State University Psychiatric Residency, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2019-06-25 |
| 1912564881 | Asmara Theresa Hoo | Psychiatry & Neurology | 965 Fee Road, Room A233, East Lansing, MI 48824 | 2019-05-24 |
| 1790276822 | Traverse Health Clinic and Coalition | Clinic/Center | East Fee Hall 965 Fee Road, Room A222, East Lansing, MI 48824 | 2018-05-24 |
| 1922598515 | Jubin Joseph Cheruvelil | Specialist/Technologist, Other | 446 W. Circle Dr. Room 249 Annex, Justin S. Morrill Hall of Agriculture, East Lansing, MI 48824 | 2018-05-18 |
| 1073003257 | Dawn Arvye Contreras | Health Educator | 446 West Circle Dr., Justin S. Morrill Hall of Agriculture, Room 166, East Lansing, MI 48824 | 2018-05-14 |
| 1710406046 | Kimberly Ann Breukink | Social Worker | 463 East Circle Drive, Michigan State University, Counseling and Psychiatric Services, East Lansing, MI 48824 | 2017-09-19 |
| 1043766314 | Ahmed Jouan | Psychiatry & Neurology | 804 Service Rd A217, East Lansing, MI 48824 | 2016-08-28 |
| Find all providers in zip 48824 | ||||
| Taxonomy Code | 2080N0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Neonatal-Perinatal Medicine |
| A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies. |
| 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/certification - 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 |
|---|---|---|---|---|
| 1477022721 | Stephanie A Cody | Pediatrics | 4625 2nd Ave Apt 109, Detroit, MI 48201-1238 | 2018-11-15 |
| 1427494889 | Danish Alamshahi Alamy Md | Pediatrics | 1 Hurley Plz # 2e, Flint, MI 48503-5902 | 2013-05-13 |
| 1073855482 | Jodi K. Garvin | Pediatrics | Helen De Vos Children's Hospital Nicu 3w, 100 Michigan St Ne, Grand Rapids, MI 49503-2560 | 2013-03-24 |
| 1205052636 | Neonatology & Inpatient Pediatrics, Inc | Pediatrics | 1964 Westlake Ct, Bloomfield Hills, MI 48302-1286 | 2007-04-17 |
| 1912933771 | June C Murphy | Pediatrics | 1400 Genesys Pkwy, Grand Blanc, MI 48439-8068 | 2006-06-24 |
| 1922096718 | William D Clark | Pediatrics | 18101 Oakwood Blvd Ste 124, Dearborn, MI 48124-4089 | 2005-10-06 |
| 1477188555 | Msu Health Care Inc | Pediatrics | 1215 E Michigan Ave, Lansing, MI 48912-1811 | 2020-03-09 |
| 1528608411 | Carl Joseph Domigan | Pediatrics | 1500 E Medical Center Dr, Ann Arbor, MI 48109-5000 | 2020-01-08 |
| 1790334217 | Adila Mohammedfawzi Abulhamail | Pediatrics | 1215 E Michigan Ave, Lansing, MI 48912-1811 | 2019-09-06 |
| 1558910216 | Mishref Mohammed Abdelhamid | Pediatrics | 1215 E Michigan Ave, Lansing, MI 48912-1811 | 2019-09-05 |
| Find all providers with the same taxonomy | ||||
| City | EAST LANSING |
| Zip Code | 48824 |
Please comment or provide details below to improve the information on MICHIGAN STATE UNIVERSITY.
| 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.