Michigan State University
Organization Active NPI Surgery Physician · East Lansing, MI
NPI 1699725895 · NPPES record last updated Oct 18, 2019
Key facts
- NPI
- 1699725895
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Surgery Physician 208600000X
- Legal business name
- MICHIGAN STATE UNIVERSITY
- Practice address
- 4660 S Hagadorn Rd Ste 600
East Lansing, MI 48823-5383 - Phone
- (517) 267-2460
- Fax
- (517) 884-8602
- NPI assigned
- May 11, 2006
- Organization subpart
- No
Authorized official
- Name
- Lisa Rucker
- Title
- Enrollment & Patient Accts Manager
- Phone
- (517) 355-8462
Other NPIs on the same Medicare enrollment 12
Practitioners 57
-
Laura E Agresta, M.D.
-
Zakia Iqbal Alavi, M.D.
-
Eric Joseph Biondo-Savin, D.O.
-
Reynard Ronald Bouknight, M.D.
-
Tyson Burghardt, MD
-
Craig E Cole, MD
-
Marie Carol Cole, M.D.
-
Jennifer R Ely, D.O.
-
Ryan Stephen Fajardo, M.D.
-
Michael T Flink, D.O.
-
Brandon Francis, MD, MPH
-
Renuka Gera, M.D.
-
John Lester Goudreau, D.O.
-
Martin E Hurwitz, MD
-
Daniel Isaac, D.O.
-
David Irwin Kaufman, D.O.
-
Ryan A Keating, D.O.
-
Suad Khalil, M.D.
-
Arya Khatiwoda, D.O.
-
Diane Marie Macdonald, M.D.
-
Michael W Masnyj, D.O.
-
Tanna S. McGee, PA
-
Michael Kent McLeod, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031105000741 | MI | Part B Supplier - Clinic/Group Practice | 3870405954 |
Receives reassigned benefits from 94 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: East Lansing, MI; Okemos, MI; Lansing, MI; Eaton Rapids, MI |
| O20031106000079 | MI | Part B Supplier - Clinic/Group Practice | 3870405954 |
Receives reassigned benefits from 52 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Haslett, MI; East Lansing, MI; Lansing, MI; Grand Rapids, MI; Eaton Rapids, MI; Charlotte, MI |
| O20031218000492 | MI | Part B Supplier - Clinic/Group Practice | 3870405954 |
Receives reassigned benefits from 23 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: East Lansing, MI; Lansing, MI |
National Provider Directory
Locations
804 Service Rd
#109F
East Lansing, MI 48824
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endocrinology, Diabetes & Metabolism Physician |
207RE0101X | |||
| Hematology & Oncology Physician |
207RH0003X | |||
| Infectious Disease Physician |
207RI0200X | |||
| Obstetrics & Gynecology Physician |
207V00000X | |||
| Reproductive Endocrinology Physician |
207VE0102X | |||
| Otolaryngology Physician |
207Y00000X | 4301097695 | MI | |
| Surgery Physician |
208600000X | Yes | ||
| Surgical Critical Care Physician |
2086S0102X | |||
| Trauma Surgery Physician |
2086S0127X | |||
| Surgical Oncology Physician |
2086X0206X | 4301077538 | MI |
Addresses
Primary practice location
4660 S Hagadorn Rd Ste 600
East Lansing, MI 48823-5383
Mailing address
804 Service Rd Ste A109B
East Lansing, MI 48824-7015
Phone (517) 267-2460
Other providers in East Lansing, MI
- Michigan State University
- Michigan State University
- Michigan State University
- Michigan State University
- Michigan State University
- Michigan State University
- Michigan State University
- Michigan State University
- Michigan State University
- Michigan State University
All providers in East Lansing, MI · Surgery Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.