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General NPI Number Information
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NPI Number | 1194737478
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Entity Type | Individual
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Provider Name | STEPHEN GARY LALKA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 08/01/2022
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Provider Practice Location Address
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Address Line | 205 N EAST AVE
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City | JACKSON
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State | MI
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Zip | 49201-1753
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Country | US
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Telephone | 517-205-7481
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Fax | 313-876-1305
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Provider Business Mailing Address
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Address Line | PO BOX 601067
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City | CHARLOTTE
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State | NC
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Zip | 28260-1067
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Country | US
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Telephone | 704-355-8188
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Fax | 704-355-8192
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2005-01060
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 01035930A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 2005-01060
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 01035930A
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 4301500422
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License Number State | MI
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