=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629364856
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHILLIP W LAMBERT MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2011
-----------------------------------------------------
Last Update Date | 06/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 341 CANTERBURY DR
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48638-5812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-793-0118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3061 CHRISTY WAY
-----------------------------------------------------
City | SAGINAW
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48603-2224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-791-2455
-----------------------------------------------------
Fax | 989-791-1392
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PHILLIP W LAMBERT
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 989-793-0118
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VE0102X
-----------------------------------------------------
Taxonomy Name | Reproductive Endocrinology Physician
-----------------------------------------------------
License Number | 4301039002
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------