Provider Demographics
NPI:1396859013
Name:MONSON, CAROL LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LYNN
Last Name:MONSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:804 SERVICE RD # A201
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:804 CLINICAL CENTER, A235
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824
Practice Address - Country:US
Practice Address - Phone:517-355-1300
Practice Address - Fax:517-355-1710
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007709207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1396859013Medicaid
MI4536644Medicaid
MI1396859013Medicaid
MI4536644Medicaid