Provider Demographics
NPI:1356355762
Name:MESSINA, EDMUND J (MD)
Entity type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:J
Last Name:MESSINA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1675 WATERTOWER PL
Mailing Address - Street 2:SUITE 600
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8043
Mailing Address - Country:US
Mailing Address - Phone:517-324-3445
Mailing Address - Fax:517-324-4330
Practice Address - Street 1:1675 WATERTOWER PL
Practice Address - Street 2:SUITE 600
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8043
Practice Address - Country:US
Practice Address - Phone:517-324-3445
Practice Address - Fax:517-324-4330
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIEM0433412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A74087Medicare UPIN
0P06470Medicare ID - Type Unspecified