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NPI Code Detail

MEDICARE: MALIA FAITH LAKE DO

MEDICARE: MALIA FAITH LAKE DO
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1255130712
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALIA FAITH LAKE DO
Provider Business Mailing Address
First Line : 2213 CHERRY ST
Second Line : ACC BASEMENT
City : TOLEDO
State : OH
Zip : 43608-2603
Country : US
Telephone Number : 419-251-6522
Fax Number : 419-251-6849
Provider Business Practice Location Address
First Line : 2213 FRANKLIN AVE
Second Line : OB/GYN 1ST FL
City : TOLEDO
State : OH
Zip : 43620-1402
Country : US
Telephone Number : 419-251-2395
Fax Number : 419-251-2401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2025
Last Update Date : 03/23/2026

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Directions to “ MALIA FAITH LAKE DO” Practice Location

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