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General NPI Number Information
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NPI Number | 1083635551
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Entity Type | Organization
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Legal Business Name | LAKESHORE SURGICARE, LLC
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3111 VILLAGE POINTE
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City | CHESTERTON
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State | IN
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Zip | 46304-9689
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Country | US
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Telephone | 219-921-1444
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Fax |
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Provider Business Mailing Address
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Address Line | 3111 VILLAGE POINTE
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City | CHESTERTON
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State | IN
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Zip | 46304-9689
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Country | US
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Telephone | 219-921-1444
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICIER
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Name | MR. ROBERT W. SCHELLER JR.
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Credential | CPA, CASC
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Telephone | 219-921-1444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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