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General NPI Number Information
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NPI Number | 1467641373
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Entity Type | Organization
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Legal Business Name | LAKESHORE PLASTIC AND RECONSTRUCTIVE SURGERY ASSOCIATES, P.C.
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3124 N WELLNESS DRIVE SUITE 10
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City | HOLLAND
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State | MI
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Zip | 49424-8121
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Country | US
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Telephone | 616-738-5870
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Fax | 616-738-5872
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Provider Business Mailing Address
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Address Line | 3124 N WELLNESS DRIVE SUITE 10
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City | HOLLAND
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State | MI
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Zip | 49424-8121
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Country | US
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Telephone | 616-738-5870
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Fax | 616-738-5872
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RYAN E DODDE II
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Credential | MD
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Telephone | 616-738-5870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State | MI
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