Provider Demographics
NPI:1053808550
Name:DR. ALLISON WOOD, DO MPH, PLLC
Entity type:Organization
Organization Name:DR. ALLISON WOOD, DO MPH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-999-5300
Mailing Address - Street 1:4136 LEGACY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4293
Mailing Address - Country:US
Mailing Address - Phone:517-999-5300
Mailing Address - Fax:517-999-5310
Practice Address - Street 1:4136 LEGACY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4293
Practice Address - Country:US
Practice Address - Phone:517-999-5300
Practice Address - Fax:517-999-5310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101018021207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty