Nicodemus, Clarence L

Nicodemus, Clarence L is an individual health care provider with primary practice located at 4660 S Hagadorn Rd Suite 500, East Lansing MI 48823-5376. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neuromusculoskeletal Medicine & OMM, which is considered as his primary health care specialty. Nicodemus, Clarence L can be contacted via phone (517) 432-6144.

Contact Information

Primary practice address
4660 S Hagadorn Rd Suite 500 East Lansing MI 48823-5376
Phone: (517) 432-6144
Fax: (517) 432-6150
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neuromusculoskeletal Medicine & OMM 204D00000X 5101016107 Michigan

Profile Details

NPI number 1063690535
LBN Legal business name Nicodemus, Clarence L
Credentials PHD DO
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 6th, 2008
Last updated Jun 26th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063690535 NPPES
Michigan MEDICAID 1063690535

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