MEDICARE: LAKE HARBOR INTERNAL MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1083800015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE HARBOR INTERNAL MEDICINE

Provider Business Mailing Address
First Line	:	3684 N HARBOR LN
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-6914
Country	:	US
Telephone Number	:	208-853-4556
Fax Number	:	208-853-5544

Provider Business Practice Location Address
First Line	:	3684 N HARBOR LN
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-6914
Country	:	US
Telephone Number	:	208-853-4556
Fax Number	:	208-853-5544

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KERILYNN ERLAND
Credential	:	M.D.
Telephone Number	:	208-853-4556

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	09/24/2007

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Practice Location Address:

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Directions to “LAKE HARBOR INTERNAL MEDICINE ” Practice Location

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