Provider Demographics
NPI:1083598916
Name:BAGASRAWALA, LAMIA
Entity type:Individual
Prefix:
First Name:LAMIA
Middle Name:
Last Name:BAGASRAWALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 MARFITT RD APT 1
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6313
Mailing Address - Country:US
Mailing Address - Phone:517-930-7151
Mailing Address - Fax:
Practice Address - Street 1:2720 E LANSING DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-7754
Practice Address - Country:US
Practice Address - Phone:517-337-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6352001159390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program