| Michigan State University Clinical Center | |
|
804 Service Rd Ste A114 East Lansing MI 48824-7038 | |
| (517) 355-7648 | |
| (517) 432-1319 |
| Full Name | Michigan State University Clinical Center |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 804 Service Rd Ste A114, East Lansing, Michigan |
| Authorized Official Name and Position | Cynthia Zaldokas (MGR PROVIDER ENROLLMENT) |
| Authorized Official Contact | 5173553503 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michigan State University Clinical Center 804 Service Rd Ste A114 East Lansing MI 48824-7038 Ph: (517) 355-7648 | Michigan State University Clinical Center 804 Service Rd Ste A114 East Lansing MI 48824-7038 Ph: (517) 355-7648 |
| NPI Number | 1255629358 |
|---|---|
| Provider Enumeration Date | 07/11/2011 |
| Last Update Date | 04/13/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255629358 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 6301014684 (Michigan) | Primary |
| 103T00000X | Psychologist | 6301006498 (Michigan) | Secondary |
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