OrganizationActive
Board of Trustees of Michigan State University
NPI 1821493974 · Pediatric Hematology & Oncology Physician · Lansing, MI
Provider details
- NPI number
- 1821493974
- Entity type
- Organization
- Primary specialty
- Pediatric Hematology & Oncology PhysicianAllopathic & Osteopathic Physicians
- Authorized official
- Lisa Rucker, Enrollment & Patient Accts Super
- License
- 4301035591 (MI)
Practice location
1200 E Michigan Ave
Ste 145
Lansing, MI 48912-1800
Phone: (517) 364-5440
Fax: (517) 364-5409
Mailing address
804 Service Rd Ste A109b
East Lansing, MI 48824-7015
Registry dates
- Enumerated
- 2014-10-31
- Last updated
- 2019-12-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.