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General NPI Number Information
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NPI Number | 1841433109
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Entity Type | Organization
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Legal Business Name | LAKE COUNTRY FAMILY MEDICINE, P.C.
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Dates
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Enumeration Date | 04/15/2009
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Last Update Date | 04/15/2009
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Provider Practice Location Address
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Address Line | 502 S MAIN ST SUITE G
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City | CANANDAIGUA
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State | NY
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Zip | 14424-2242
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Country | US
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Telephone | 585-394-1875
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Fax | 866-285-9069
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Provider Business Mailing Address
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Address Line | 502 S MAIN ST SUITE G
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City | CANANDAIGUA
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State | NY
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Zip | 14424-2242
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Country | US
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Telephone | 585-394-1875
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Fax | 866-285-9069
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. KERRY W GRAFF
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Credential | M.D.
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Telephone | 585-394-1875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 207638
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License Number State | NY
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