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General NPI Number Information
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NPI Number | 1508936311
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Entity Type | Organization
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Legal Business Name | LAKESHORE MAMMOGRAPHY CENTER PC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 39200 GARFIELD RD SUITE A
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-4095
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Country | US
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Telephone | 586-228-8000
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Fax | 586-228-7870
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Provider Business Mailing Address
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Address Line | 39200 GARFIELD RD SUITE A
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48038-4095
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Country | US
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Telephone | 586-228-8000
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Fax | 586-228-7870
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. JUDITH A SUTHERLAND
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Credential |
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Telephone | 586-228-8000
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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 | MI
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