Provider Demographics
NPI:1245223528
Name:PAPSON, MICHAEL DOUGLAS (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:PAPSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 W LAKE LANSING RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8528
Mailing Address - Country:US
Mailing Address - Phone:517-853-7500
Mailing Address - Fax:517-853-0142
Practice Address - Street 1:612 W LAKE LANSING RD
Practice Address - Street 2:SUITE 700
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8528
Practice Address - Country:US
Practice Address - Phone:517-853-7500
Practice Address - Fax:517-853-0142
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001875213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4134862Medicaid
MI4134862Medicaid
OM72200Medicare ID - Type Unspecified