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General NPI Number Information
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NPI Number | 1366724437
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Entity Type | Organization
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Legal Business Name | LAKELAND MEDICAL PRACTICES
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Dates
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Enumeration Date | 09/15/2011
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 1234 NAPIER AVE
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-2112
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Country | US
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Telephone | 269-983-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 1234 NAPIER AVE
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-2112
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Country | US
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Telephone | 269-983-8300
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Fax |
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Authorized Official
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Title or Position | VP PRACTICE OFFICES
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Name | WARREN WHITE JR.
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Credential |
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Telephone | 269-983-8304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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