MEDICARE: DR. CHARLES M LAKIN M.D.

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	208800000X	Urology Physician	G38869	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548272198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES M LAKIN M.D.

Provider Business Mailing Address
First Line	:	200 W ARBOR DRIVE
Second Line	:	MAILCODE 8897
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-8897
Country	:	US
Telephone Number	:	619-543-3573
Fax Number	:	619-543-3475

Provider Business Practice Location Address
First Line	:	200 W ARBOR DRIVE
Second Line	:	MEDICAL OFFICES NORTH SUITE 3-4
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-8706
Country	:	US
Telephone Number	:	619-543-3572
Fax Number	:	619-543-3475

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	11/16/2010

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