Registry details
Type
Individual
Primary specialty
Dermatology
Enumerated
May 28, 2019
License(s)
4301508623 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 2601 COOLIDGE RD STE 200 | East Lansing, MI 48823-6381 | 517-203-3000 |
| MAILING | 801 YORK ST | Manitowoc, WI 54220-4630 | 920-663-9008 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.