DR. STACY SUZANNE BULL (NPI# 1619071115) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619071115 |
| Entity Type | Individual |
| Full Name | DR. STACY SUZANNE BULL |
| Other Name | DR. STACY SUZANNE DUCKLOW |
| Credential | MD |
| Practice Address |
463 E Circle Dr East Lansing MI 48824-7500 |
| Mailing Address |
804 Service Rd # A109f East Lansing MI 48824-7015 |
| Practice Telephone | 5178846502 |
| Practice Fax Number | 5173559265 |
| Mailing Telephone | 5178842976 |
| Mailing Fax Number | 5174323928 |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2018-09-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
4301070974 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1619071115 | 05 | |
| MI | 4546883 | 05 | |
| MI | BCBS INDIVIDUAL PIN | 0803310501 | 01 |
| Street Address |
463 E CIRCLE DR |
| City | EAST LANSING |
| State | MI |
| Zip Code | 48824-7500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639150683 | Patricia Ann Ryan | Family Medicine | 463 E Circle Dr, East Lansing, MI 48824-7505 | 2005-11-08 |
| 1528685732 | Basak Amelia Khamush | Psychologist | 463 E Circle Dr, East Lansing, MI 48824-7500 | 2020-07-03 |
| 1780066894 | Sarah Elizabeth Fay-simons | Social Worker | 463 E Circle Dr, Room 123, East Lansing, MI 48824-7500 | 2015-06-25 |
| 1366821324 | Chetan Chauhan | Psychiatry & Neurology | 463 E Circle Dr, East Lansing, MI 48824-7500 | 2015-05-23 |
| 1063813889 | Dawn M Goldstein | Nurse Practitioner | 463 E Circle Dr, East Lansing, MI 48824-7500 | 2014-09-11 |
| 1932508116 | Chanda Bolander | Social Worker | 463 E Circle Dr, Rm 123, East Lansing, MI 48824-7505 | 2014-08-14 |
| 1336563485 | Nancy Fontus | Pharmacist | 463 E Circle Dr, Room103, East Lansing, MI 48824-7505 | 2014-02-10 |
| 1467740878 | Tami Jean Hiser | Nurse Practitioner | 463 E Circle Dr, East Lansing, MI 48824-7500 | 2011-07-19 |
| 1003115718 | Angela J H Arsenault | Nurse Practitioner | 463 E Circle Dr, East Lansing, MI 48824-7500 | 2011-03-21 |
| 1801119532 | Susan R Wilson | Nurse Practitioner | 463 E Circle Dr, East Lansing, MI 48824-7500 | 2010-03-09 |
| Find all providers in the same location | ||||
| 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 | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427340256 | Jill S Moschelli | Family Medicine | 4660 S Hagadorn Rd Ste 420, East Lansing, MI 48823-5353 | 2011-05-12 |
| 1699858431 | Michigan State University | Family Medicine | 4660 S Hagadorn Rd Ste 420, East Lansing, MI 48823-5353 | 2006-10-23 |
| 1912011594 | Lawrence Gerard Nassar | Family Medicine | 4660 S Hagadorn Rd, Suite 420, East Lansing, MI 48823-5376 | 2006-08-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013413236 | Sports and Regenerative Medicine Pllc | Family Medicine | 526 W Genesee St Ste 3, Frankenmuth, MI 48734-1357 | 2018-04-05 |
| 1982138442 | Stephen Michael Spadafore | Family Medicine | 2951 Earhart Rd, Ann Arbor, MI 48105-9728 | 2017-04-11 |
| 1447606801 | Central Michigan University | Family Medicine | Cmu Sports Medicine, Rose 100, Mt Pleasant, MI 48859-0001 | 2016-05-04 |
| 1962808162 | Mclaren Greater Lansing | Family Medicine | 2479 Woodlake Cir, Suite 340, Okemos, MI 48864 | 2014-11-15 |
| 1306080213 | Caroline E Beall | Family Medicine | 11160 Wj Presley Pkwy Ste 100, Allendale, MI 49401-8075 | 2009-04-22 |
| 1104038629 | Robert Edward Poley | Family Medicine | 15959 Hall Rd Ste 405, Macomb, MI 48044 | 2007-05-04 |
| 1063563187 | Lee Stephen Fruman | Family Medicine | 24670 S Cromwell Dr, Franklin, MI 48025-1644 | 2007-01-15 |
| 1366505802 | Sports Medicine Associates,plc | Family Medicine | 3121 University Dr, Ste 140, Auburn Hills, MI 48326-2385 | 2006-12-18 |
| 1538220561 | Thomas K Jamieson | Family Medicine | 2720 Pleasant Grove Rd, Lansing, MI 48910-2410 | 2006-12-13 |
| 1366550105 | D-care PC | Family Medicine | 25932 Dequindre Rd, Suite C, Warren, MI 48091-1071 | 2006-08-29 |
| Find all providers with the same taxonomy | ||||
| City | EAST LANSING |
| Zip Code | 48824 |
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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.