Provider Demographics
NPI:1467697482
Name:MSU / SPARROW HEALTH SYSTEM
Entity Type:Organization
Organization Name:MSU / SPARROW HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TAQATQA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-476-0028
Mailing Address - Street 1:901 E MOUNT HOPE AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-3207
Mailing Address - Country:US
Mailing Address - Phone:517-485-1153
Mailing Address - Fax:
Practice Address - Street 1:1215 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1811
Practice Address - Country:US
Practice Address - Phone:517-364-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.054444282N00000X
MI4301096500282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital