Provider Demographics
NPI:1760661722
Name:DR. JANET SPRAGUE, D.O. PC
Entity Type:Organization
Organization Name:DR. JANET SPRAGUE, D.O. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-627-1000
Mailing Address - Street 1:820 CHARLEVOIX DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-7100
Mailing Address - Country:US
Mailing Address - Phone:517-627-1000
Mailing Address - Fax:517-627-1004
Practice Address - Street 1:820 CHARLEVOIX DR
Practice Address - Street 2:SUITE 220
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-7100
Practice Address - Country:US
Practice Address - Phone:517-627-1000
Practice Address - Fax:517-627-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJS012810207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIJS012810OtherLIC #
MI4427238Medicaid
MI0852310424OtherBCBS
MI0P18400Medicare PIN
MI0852310424OtherBCBS