Healthcare Provider Details

I. General information

NPI: 1669465761
Provider Name (Legal Business Name): JOHN ERNEST LAMACCHIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 W UNIVERSITY DR STE 450
ROCHESTER MI
48307-1871
US

IV. Provider business mailing address

1135 W UNIVERSITY DR SUITE 450
ROCHESTER MI
48307-1871
US

V. Phone/Fax

Practice location:
  • Phone: 248-650-2400
  • Fax: 248-650-4596
Mailing address:
  • Phone: 248-650-2400
  • Fax: 248-650-4596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number4301074146
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: