Provider Demographics
NPI:1326731050
Name:HEALTHY COCOON PRACTICE PLLC
Entity Type:Organization
Organization Name:HEALTHY COCOON PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-246-1375
Mailing Address - Street 1:27082 W. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EDWARDSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49112
Mailing Address - Country:US
Mailing Address - Phone:269-246-1375
Mailing Address - Fax:
Practice Address - Street 1:27082 W. MAIN STREET
Practice Address - Street 2:
Practice Address - City:EDWARDSBURG
Practice Address - State:MI
Practice Address - Zip Code:49112
Practice Address - Country:US
Practice Address - Phone:269-246-1375
Practice Address - Fax:269-246-1376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty