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General NPI Number Information
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NPI Number | 1396251468
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Entity Type | Organization
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Legal Business Name | LAKESHORE CARDIOVASCULAR INSTITUTE LLC
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Dates
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Enumeration Date | 12/27/2017
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Last Update Date | 05/06/2019
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Provider Practice Location Address
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Address Line | 8733 W 400 N
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City | MICHIGAN CITY
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State | IN
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Zip | 46360
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Country | US
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Telephone | 219-879-0333
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Fax | 219-879-0325
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Provider Business Mailing Address
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Address Line | 8733 W 400 N
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-9330
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Country | US
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Telephone | 219-878-3217
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Fax | 224-633-1935
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAMMI M DALI
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Credential | MD
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Telephone | 219-878-3217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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