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General NPI Number Information
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NPI Number | 1801329321
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Entity Type | Organization
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Legal Business Name | LAKESHORE SURGICAL LLC
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 1207 N HOUSTON AVE
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City | HUMBLE
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State | TX
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Zip | 77338-2591
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Country | US
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Telephone | 832-916-2422
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Fax | 832-916-2522
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Provider Business Mailing Address
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Address Line | 1207 N HOUSTON AVE
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City | HUMBLE
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State | TX
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Zip | 77338-2591
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Country | US
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Telephone | 832-916-2422
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Fax | 832-916-2522
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Authorized Official
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Title or Position | CEO
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Name | DR. ANGELA MICHELLE LEWIS-TRAYLOR
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Credential | MD
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Telephone | 832-916-2422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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