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NPI Code Detail

MEDICARE: LAKELAND MEDICAL PRACTICES

MEDICARE: LAKELAND MEDICAL PRACTICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084N0400XNeurology Physician

General Provider Information

NPI Number : 1174038392
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKELAND MEDICAL PRACTICES
Provider Business Mailing Address
First Line : 3950 HOLLYWOOD RD STE 230
Second Line :
City : SAINT JOSEPH
State : MI
Zip : 49085-9158
Country : US
Telephone Number : 269-985-0000
Fax Number : 269-985-0360
Provider Business Practice Location Address
First Line : 3950 HOLLYWOOD RD STE 230
Second Line :
City : SAINT JOSEPH
State : MI
Zip : 49085-9158
Country : US
Telephone Number : 269-985-0000
Fax Number : 269-985-0360
Authorized Official
Title or Position : MEDICAL STAFF COORDINATOR
Name : MORGAN VINCENT
Credential :
Telephone Number : 269-983-8282
Provider Enumeration Date : 12/11/2017
Last Update Date : 12/11/2017

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Directions to “LAKELAND MEDICAL PRACTICES ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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