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General NPI Number Information
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NPI Number | 1144404724
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Entity Type | Organization
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Legal Business Name | LAKELAND GENERAL SURGERY
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 60 N SAINT JOSEPH AVE SUITE E
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City | NILES
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State | MI
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Zip | 49120-2296
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Country | US
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Telephone | 269-684-6696
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Fax | 269-684-5286
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Provider Business Mailing Address
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Address Line | 60 N SAINT JOSEPH AVE SUITE E
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City | NILES
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State | MI
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Zip | 49120-2296
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Country | US
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Telephone | 269-684-6696
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Fax | 269-684-5286
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Authorized Official
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Title or Position | VP OPERATIONS & FACILITY MANGEMENT
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Name | DENNIS MACK
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Credential |
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Telephone | 269-983-8399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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