Provider Demographics
NPI:1275655920
Name:CORNERSTONE FAMILY PRACTICE, PLC
Entity type:Organization
Organization Name:CORNERSTONE FAMILY PRACTICE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-333-4600
Mailing Address - Street 1:2852 EYDE PKWY
Mailing Address - Street 2:SUITE 175
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-5378
Mailing Address - Country:US
Mailing Address - Phone:517-333-4600
Mailing Address - Fax:517-333-4996
Practice Address - Street 1:2852 EYDE PKWY STE 175
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5378
Practice Address - Country:US
Practice Address - Phone:517-333-4600
Practice Address - Fax:517-333-4996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080C311550OtherBCBS
MIG07108OtherBCN GRP
MIG07108OtherBCN GRP