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General NPI Number Information
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NPI Number | 1538397120
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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 | 06/23/2009
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Last Update Date | 12/17/2023
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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 | 269-428-5007
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Fax | 269-428-2789
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Provider Business Mailing Address
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Address Line | PO BOX 708
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-0708
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Country | US
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Telephone | 269-428-5007
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Fax | 269-428-2789
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Authorized Official
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Title or Position | V.P. LAKELAND PHYSICIAN PRACTICES
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Name | WARREN WHITE
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Credential |
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Telephone | 269-983-8127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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