Provider Demographics
NPI:1386119808
Name:RED CEDAR PODIATRY PC
Entity type:Organization
Organization Name:RED CEDAR PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:STINES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:517-243-8333
Mailing Address - Street 1:3937 PATIENT CARE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4287
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3937 PATIENT CARE DR
Practice Address - Street 2:STE 104
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4891
Practice Address - Country:US
Practice Address - Phone:517-243-8333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty