Provider Demographics
NPI:1104853126
Name:SCHLEGA, MEKETA M (MD)
Entity Type:Individual
Prefix:
First Name:MEKETA
Middle Name:M
Last Name:SCHLEGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 LAKE LANSING RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3756
Mailing Address - Country:US
Mailing Address - Phone:517-913-3800
Mailing Address - Fax:517-913-3801
Practice Address - Street 1:1540 LAKE LANSING RD
Practice Address - Street 2:SUITE 107
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3756
Practice Address - Country:US
Practice Address - Phone:517-913-3800
Practice Address - Fax:517-913-3801
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010501212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301924Medicaid
MI310B510660OtherBCBSM
MI300119615OtherRAILROAD MEDICARE
MI300119615OtherRAILROAD MEDICARE
MI0M32800016Medicare PIN