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General NPI Number Information
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NPI Number | 1548588031
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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 | 05/10/2010
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 2002 S 11TH ST
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City | NILES
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State | MI
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Zip | 49120-4074
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Country | US
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Telephone | 269-687-0200
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Fax | 269-684-0199
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Provider Business Mailing Address
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Address Line | 6416 DEANS HILL RD
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City | BERRIEN CENTER
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State | MI
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Zip | 49102-9750
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Country | US
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Telephone | 269-471-7741
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Fax | 269-471-1581
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Authorized Official
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Title or Position | VICE PRESIDENT 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 | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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