BOARD OF TRUSTEES OF MICHIGAN STATE UNIVERSITY (NPI# 1821493974) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821493974 |
| Entity Type | Organization |
| Organization Name | BOARD OF TRUSTEES OF MICHIGAN STATE UNIVERSITY |
| Other Organization Name | MSU CMDS CLINIC |
| Practice Address |
1200 E Michigan Ave Ste 145 Lansing MI 48912-1800 |
| Mailing Address |
804 Service Rd Ste A109b East Lansing MI 48824-7015 |
| Practice Telephone | 5173645440 |
| Practice Fax Number | 5173645409 |
| Mailing Telephone | 5178842976 |
| Mailing Fax Number | 5174323928 |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2019-12-13 |
| Authorized Official Name | LISA M RUCKER (ENROLLMENT & PATIENT ACCTS SUPER) |
| Authorized Official Telephone | 5173558462 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207K00000X | Allergy & Immunology | 4301035591 | MI | Allopathic & Osteopathic Physicians |
| N | 207RH0003X |
Internal Medicine Specialization: Hematology & Oncology |
4301021298 | MI | Allopathic & Osteopathic Physicians |
| N | 2080P0214X |
Pediatrics Specialization: Pediatric Pulmonology |
4301035591 | MI | Allopathic & Osteopathic Physicians |
| Y | 2080P0207X |
Pediatrics Specialization: Pediatric Hematology-Oncology |
4301045225 | MI | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| MSU CMDS CLINIC | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992242267 | Board of Trustees of Michigan State University | Community/Behavioral Health | 4930 S Hagadorn Rd, East Lansing, MI 48823-5312 | 2017-01-25 |
| 1629157979 | Board of Trustees of Michigan State University | Clinical Medical Laboratory | 1355 Bogue Street, Room B123, East Lansing, MI 48824-6239 | 2006-11-06 |
| 1770646028 | Board of Trustees of Michigan State University | Family Medicine | 463 E Circle Dr, East Lansing, MI 48824-7500 | 2006-12-18 |
| 1144309642 | Board of Trustees of Michigan State University | Clinical Medical Laboratory | 463 E Circle Dr, East Lansing, MI 48824-7500 | 2006-11-03 |
| Street Address |
1200 E MICHIGAN AVE STE 145 |
| City | LANSING |
| State | MI |
| Zip Code | 48912-1800 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942202494 | Shirley R Courey | Nurse Practitioner | 1200 E Michigan Ave, Suite 500, Lansing, MI 48912-1800 | 2005-08-15 |
| 1205444866 | Anthony Griffin | Nurse Practitioner | 1200 E Michigan Ave, Lansing, MI 48912-1800 | 2020-07-20 |
| 1255967725 | Rachel Gibney | Registered Nurse | 1200 E Michigan Ave, Lansing, MI 48912-1800 | 2020-03-17 |
| 1104398684 | Emma Skye Sanger | Speech-Language Pathologist | 1200 E Michigan Ave, Lansing, MI 48912-1800 | 2018-12-21 |
| 1548732175 | Madalina Ioana Hill | Physical Therapist | 1200 E Michigan Ave, Lansing, MI 48912-1800 | 2018-12-20 |
| 1376010462 | Taryn Noelle Edsall | Physical Therapist | 1200 E Michigan Ave, Lansing, MI 48912-1800 | 2018-10-27 |
| 1962996470 | Danielle Mugerian | Student in an Organized Health Care Education/Training Program | 1200 E Michigan Ave, Lansing, MI 48912-1800 | 2018-06-18 |
| 1669960605 | Stephen Sudekum | Student in an Organized Health Care Education/Training Program | 1200 E Michigan Ave, Lansing, MI 48912-1800 | 2018-04-25 |
| 1275039547 | Angela Chapman | Occupational Therapist | 1200 E Michigan Ave, Lansing, MI 48912-1800 | 2018-04-04 |
| 1689176984 | Laura Barrons | Physical Therapist | 1200 E Michigan Ave, Lansing, MI 48912-1800 | 2018-03-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316563646 | Shelley Gabel | Surgery | 1200 E Michigan Ave., Sparrow Professional Building Suite 655, Lansing, MI 48912 | 2020-06-23 |
| 1568087237 | Ahmed Mohamed Haggag | Student in an Organized Health Care Education/Training Program | 1215 East Michigan Avenue 3rd Floor, Lansing, MI 48912 | 2020-06-09 |
| 1467074773 | Craig Hargurkirat Malli | Family Medicine | 1215 E Michigan Avenue Suite 245, Lansing, MI 48912 | 2020-05-08 |
| 1215558945 | Temmy J. Brotherson | Family Medicine | Sparrow Health Systems, 1200 E Michigan Avenues, Suite 245, Lansing, MI 48912 | 2020-05-05 |
| 1386265452 | Kyle Patrick Doran | Emergency Medicine | Sparrow Health System, 1215 E Michigan Avenue, Lansing, MI 48912 | 2020-04-30 |
| 1316418841 | Andrea Mcswain Do PC | Obstetrics & Gynecology | 1909 E. Michigan Ave, Lansing, MI 48912 | 2018-12-10 |
| 1215386115 | Michael Vernon Hollis | Student in an Organized Health Care Education/Training Program | 1500 E Michigan Ave, Suite 655, Lansing, MI 48912 | 2016-06-10 |
| 1518333970 | Eastside Community Action Center | Social Worker | 1001 Dakin Street, Suite B, Lansing, MI 48912 | 2015-08-19 |
| 1649667403 | Cheryl Ann Wade | Counselor | 1712 E Michigan Ave., Lansing, MI 48912 | 2015-04-20 |
| 1083006134 | Carol Pratt | Occupational Therapist | 1200 E. Michigan Ave, Outpatient Rehab - Lower Level, Lansing, MI 48912 | 2015-02-26 |
| Find all providers in zip 48912 | ||||
| Taxonomy Code | 2080P0207X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Hematology-Oncology |
| A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous diseases. |
| 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) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740802958 | Msu Health Care Inc. | Pediatrics | 1200 E Michigan Ave Ste 145, Lansing, MI 48912-1897 | 2020-05-11 |
| 1487920807 | Laura E Agresta | Pediatrics | 1200 E Michigan Ave Ste 145, Lansing, MI 48912-1897 | 2012-03-29 |
| 1033127626 | Renuka Gera | Pediatrics | 1200 E Michigan Ave, Ste 145, Lansing, MI 48912-1800 | 2006-08-03 |
| 1972517811 | Roshni Kulkarni | Pediatrics | 1200 E Michigan Ave, Suite 145, Lansing, MI 48912-1800 | 2006-07-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306208244 | Spectrum Health Hospitals | Pediatrics | 217 S Madison, Traverse City, MI 49684 | 2016-03-21 |
| 1124347497 | George Lewis Royer Jr. | Pediatrics | 1750 Greenbriar Dr, Portage, MI 49024-5785 | 2010-05-25 |
| 1679701692 | Tania Tusharkanti Sarker | Pediatrics | 2700 Hamlin Boulevard, Inkster, MI 48141 | 2009-06-29 |
| 1942403720 | Troy Christopher Quigg | Pediatrics | 100 Michigan St Ne Fl 10, Grand Rapids, MI 49503-2560 | 2007-06-07 |
| 1922063478 | Laura K Gowans | Pediatrics | 3577 West 13 Mile Road, Suite 101, Royal Oak, MI 48073 | 2006-04-19 |
| 1427051200 | Joseph Mirro Jr. | Pediatrics | 200 N Park St, West Michigan Cancer Center, Kalamazoo, MI 49007-3731 | 2005-05-24 |
| 1972030567 | Jillian Lapinski | Pediatrics | 1500 E Medical Center Dr, Ann Arbor, MI 48109-5000 | 2017-05-15 |
| 1689037954 | Joshua Goldman | Pediatrics | 1500 E Medical Center Dr, Ann Arbor, MI 48109 | 2016-04-03 |
| 1023402906 | Charles Nathaniel Nessle | Pediatrics | 1500 E. Medical Center Drive, Ann Arbor, MI 48109 | 2015-03-27 |
| 1801298799 | Bronson Methodist Hospital | Pediatrics | 601 John St, Suite M005, Kalamazoo, MI 49007-5341 | 2014-09-23 |
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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.