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General NPI Number Information
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NPI Number | 1396383204
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Entity Type | Organization
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Legal Business Name | LAKELAND ANESTHESIA, PC
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Dates
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Enumeration Date | 12/11/2019
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Last Update Date | 12/11/2019
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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 | 616-364-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 3333 EVERGREEN DR NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-9493
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Country | US
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Telephone | 616-364-4200
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JACK DILLON
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Credential |
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Telephone | 616-284-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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