Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Clarence L Nicodemus, PHDDO

Individual provider Neuromusculoskeletal Medicine & OMM Physician · NPI 1063690535

Clarence L Nicodemus, PHDDO is an Osteopathic Manipulative Medicine in East Lansing, Michigan. Graduated from Michigan State University College of Osteopathic Medicine in 2000, 26 years ago. Practices with Msu Health Care Inc, a 201-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
26
Trained at
Michigan State University College of Osteopathic Medicine
Licensed in
MI
In the registry since
2008
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Practice location Address checks out

4660 S Hagadorn Rd Ste 500
East Lansing, MI 48823-5376
Phone: (517) 432-6144
Fax: (517) 432-6150
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Neuromusculoskeletal Medicine & OMM Physician (primary) Taxonomy 204D00000X · Licence 5101016107 (MI)

Record details

NPI number1063690535
Entity typeIndividual (Type 1)
GenderMale
Credentials PHDDO
Sole proprietorNo
NPI enumeratedFebruary 6, 2008
Last updated in NPPESJune 26, 2023
Certification dateJune 26, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOSTEOPATHIC MANIPULATIVE MEDICINE
Medical schoolMICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
Graduated 2000 (26 years in practice)
Group practice Msu Health Care Inc. — 201 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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