Provider Demographics
NPI:1487981676
Name:MICHIGAN STATE UNIVERSITY
Entity type:Organization
Organization Name:MICHIGAN STATE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER CREDENTIALING/ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZALDOKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-355-3503
Mailing Address - Street 1:4660 S HAGADORN RD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5376
Mailing Address - Country:US
Mailing Address - Phone:517-884-6100
Mailing Address - Fax:517-884-6233
Practice Address - Street 1:4660 S HAGADORN RD
Practice Address - Street 2:SUITE 420
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5376
Practice Address - Country:US
Practice Address - Phone:517-884-6100
Practice Address - Fax:517-884-6233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOC36093Medicare PIN