Healthcare Provider Details

I. General information

NPI: 1477030476
Provider Name (Legal Business Name): ECS LAKESHORE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 E PARKDALE AVE
MANISTEE MI
49660-9709
US

IV. Provider business mailing address

PO BOX 30516 DEPT. 4111
LANSING MI
48909-8016
US

V. Phone/Fax

Practice location:
  • Phone: 231-398-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN THROOP
Title or Position: PRESIDENT
Credential: MD
Phone: 616-988-8220