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General NPI Number Information
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NPI Number | 1588941066
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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 | 11/10/2011
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 815 SAINT JOSEPH DR
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-2529
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Country | US
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Telephone | 269-983-3455
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Fax | 269-983-5920
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Provider Business Mailing Address
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Address Line | 815 SAINT JOSEPH DR
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-2529
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Country | US
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Telephone | 269-983-3455
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Fax | 269-983-5920
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Authorized Official
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Title or Position | VICE PRESIDENT PHYSICIAN PRACTICES
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Name | WARREN WHITE JR.
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Credential |
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Telephone | 269-983-8304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 4301063125
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License Number State | MI
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