Provider Demographics
NPI:1700984903
Name:REGAL, CLARA (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARA
Middle Name:
Last Name:REGAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-364-6253
Mailing Address - Fax:517-364-6204
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:STE 445
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-364-5210
Practice Address - Fax:517-364-5216
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058109207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000002595OtherPHP PIN #
MI3456084Medicaid
MI4307605Medicaid
MI1603302822OtherBCBS INDIVIDUAL PIN
MIG15364Medicare UPIN
MIM98160007Medicare PIN