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General NPI Number Information
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NPI Number | 1003096991
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Entity Type | Organization
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Legal Business Name | LAKESHORE ENT
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 1305 PALUXY RD SUITE A
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City | GRANBURY
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State | TX
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Zip | 76048-5641
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Country | US
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Telephone | 817-573-6673
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Fax | 817-573-9783
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Provider Business Mailing Address
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Address Line | 1305 PALUXY RD SUITE A
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City | GRANBURY
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State | TX
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Zip | 76048-5641
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Country | US
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Telephone | 817-573-6673
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Fax | 817-573-9783
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN GEORGE KRZEMINSKI
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Credential | D.O., FAOCO
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Telephone | 817-573-6673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | K8272
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License Number State | TX
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