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General NPI Number Information
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NPI Number | 1245260371
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Entity Type | Organization
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Legal Business Name | LAKESHORE SPINE AND PAIN P C
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 06/03/2011
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Provider Practice Location Address
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Address Line | 5511 W US HIGHWAY 10
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City | LUDINGTON
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State | MI
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Zip | 49431-2455
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Country | US
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Telephone | 231-843-1553
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Fax | 231-845-7056
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Provider Business Mailing Address
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Address Line | 5511 W US HIGHWAY 10
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City | LUDINGTON
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State | MI
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Zip | 49431-2455
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Country | US
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Telephone | 231-843-1553
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Fax | 231-845-5515
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RAJ C MAKWANA
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Credential |
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Telephone | 231-843-1553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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